This issue provides an overview of various and timely topics to our readers including pediatric nutrition screening, dietary intake of patients undergoing cardiac rehabilitation, the impact of food odors on appetite, and enteral nutrition adequacy in the intensive care unit (ICU). Two articles explore the issue of providing nutrition therapy remotely, an active challenge to many clinicians in our current pandemic. A systematic review examines the role of the Dietary Approaches to Stop Hypertension (DASH) diet in lowering blood pressure in hypertensive individuals. Critical thinking skills of registered dietitian nutritionists (RDNs) are examined, raising awareness of this important topic. Finally, a case study discusses the utility of a blenderized tube feeding (BTF) in radioactive iodine (RAI) ablation treatment.
Yeo et al validated the 3-Minute Nutrition Screening-Paediatric (Paediatric 3-MinNS) tool with the Screening Tool for the Assessment of Malnutrition in Pediatrics on pediatric patients admitted to the University Malaya Medical Center in Kuala Lumpur, Malaysia. The cross-sectional study of 165 patients demonstrated that the Paediatric 3-MinNS tool was able to accurately identify undernourished children, suggesting that this tool offers a valid and reliable way to nutritionally screen pediatric patients in this population.
Laursen et al of Aalborg and Aarhus Universities in Denmark evaluated 186 participants with ischemic heart disease engaged in a 4-week cardiac rehabilitation program. A food frequency questionnaire was used to assess dietary intake longitudinally before, during, and after rehabilitation program completion. Trends in improvement of quality of food as well as greater heart healthy food intake were noted.
Nunokawa et al of Niigata University of Health and Welfare in Japan evaluated the effect on food odors, specifically consomme, sauce, and curry, on subjective appetite and favorability in patients in a rehabilitation ward. Although sauce and curry enhanced subjective appetite degree, none of the samples affected the degree of favorability. Further research could identify whether these flavors would improve food intake in this population.
Ozen et al conducted a prospective, descriptive study examining the adequacy of enteral nutrition (EN) on the third day of EN in 105 ICU patients in 3 mixed ICUs. The nutrition regimen was overseen by a nutrition support team comprising a dietitian, a physician, and a nurse who made twice-daily visits to the patients to manage the nutrition regimen. They found that nutrition was adequate, defined as 80% to 110% of required energy intake, in 95.5% of patients. Their results highlight the significant role of the multidisciplinary approach in the management of nutrition support.
Whitcomb et al at the University of Arkansas for Medical Sciences compared in-person, Web-based, and a combination of in-person and Web-based nutrition education in pregnant women with diabetes using a pre/posttest design. They found no statistical difference among the 3 intervention formats in pretest and posttest scores, although a significant change from pretest to posttest was found in each group. The largest improvement in correct answers was seen in the combination of in-person and Web-based classes. The advantages and disadvantages of each format are discussed to highlight best ways to increase nutrition knowledge and improve outcomes.
Zozula et al of Simmons University conducted a qualitative cross-sectional study of 196 practicing RDNs to describe telehealth usage in dietetics prior to the pandemic. Their findings identified that usage was prevalent across the United States, with a nonsignificant finding of greater usage in those 56 years and younger. Barriers that were identified included Internet issues, difficulty coordinating visits, patient disengagement, and patient-related technology issues. There was a large variation in telehealth platforms used and RDN's desire to access this technology in various arenas. Further research of RDNs' use of telehealth since the pandemic will help continue to describe the role of telehealth in dietetics.
Serna et al of Case Western Reserve University conducted a cross-sectional study to evaluate the critical thinking and disposition skills of RDNs. Although the study was not sufficiently powered, their findings identify that RDNs have relatively strong critical thinking skills. Improving deduction, numeracy, interpretation, and evaluation skills were identified as important to RDNs. This study contributes to the scant literature on this topic and serves to bring dietetics in line with other allied health professions on critical thinking research.
Johnson et al describe the case of a patient with metastatic thyroid cancer undergoing RAI treatment necessitating a pretreatment low iodine diet. The commercial enteral formula consumed by the patient was too high in iodine and was preventing achievement of his pretreatment dietary goals. Supplementation with a BTF, a whole-food-based product that is naturally low in iodine, made it possible to achieve a low iodine consumption. The case provides an overview of BTF including history, common uses, potential advantages over commercial formulas, as well as their unique utility in various clinical situations.
Balasubramaniam and Hewlings of Central Michigan University conducted a systematic review to assess the efficacy of the DASH diet in lowering blood pressure in hypertensive and prehypertensive adults. Their evaluation of 8 randomized trials and secondary analyses of adults without other comorbidities revealed that the DASH diet is successful in lowering blood pressure, especially when combined with sodium reduction, weight loss, and exercise. Future research should consider dietary adherence as well as generalizability of the diet to populations across the globe.
It has been a privilege to work with the authors, reviewers, and editorial board members of Topics in Clinic Nutrition over my first year as editor. Assembling articles that are relevant and useful to our readers continues to be an important and challenging task. Thank you to the editorial board, especially Dr Judith Gilbride and Liz Young, for their support and mentorship over this past year. Thank you for your continued support of the journal.
-Kelly Kane, MS, RD, CNSC
Editor