SUNDAY, NOVEMBER 7

POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY

The Effect of Medical Nutrition Therapy on Behavior Change and Clinical Outcomes for Clients Participating in a Cardiac Rehabilitation Program Author(s): V. L. Brown, W. M. Koszewski, T. Carr, T. Housh, J. A. Fischer; Nutrition and Health Sciences, University of Nebraska -Lincoln, Lincoln, NE Learning Outcome: The participant will be able to determine if medical nutrition therapy effects behavior change and clinical outcomes for clients participating in a cardiac rehabilitation program. Background: To determine the effect of medical nutrition therapy on behavior change and clinical outcomes for clients participating in a cardiac rehabilitation program. Methods: Subjects were 36 voluntary clients from two Northeast Nebraska cardiac rehabilitation programs. Twenty-ve participants completed all phases of the study which included taking the Oregon Health Sciences Centers Diet Habit Survey for Cardiac Rehabilitation and collection of weight, body mass index, systolic and diastolic blood pressure measurements at the beginning and at the completion of the cardiac rehabilitation program. Each participant met with a registered dietitian individually and attended six nutrition lessons related to the nutrition modications for cardiovascular disease treatment and prevention. Results: Analysis of the data involved comparison of the survey and physical results between the rst and second occasions of data collection. Pre-test to post-test result comparisons with a paired t-test showed a signicant difference (p0.05) observed in the categories of meat, sh and poultry; dairy products and eggs; fats and oils; sweets and snacks; salt; restaurants and recipes and dietary survey results overall. With regard to the physical data collected, a signicant difference (p0.05) was observed pertaining to improvement in weight and body mass index results when both data collections periods were analyzed. Conclusions: The results of this research provide basic support for medical nutrition therapy and a registered dietitians involvement on behavior change and clinical outcomes in cardiac rehabilitation programs. Further research related to the long-term adherence of this population to a nutrition prescription is needed. Funding Disclosure: None

Cumulative Energy Balance in Mechanically-Ventilated Patients in the Intensive Care Unit Author(s): W. Phillips,1 J. Maas,2 K. Lee3; 1Morrison Healthcare, Bakerseld, CA, 2Consulting RD, Bakerseld, CA, 3Cal Poly University, Pomona, CA Learning Outcome: Participants will be able to identify at least 3 methods to improve administration of enteral nutrition in the ICU. Purpose: ASPEN recommends early enteral feeding for improved patient outcomes, such as decreased infections and ICU length of stay and improved lean body mass and disease severity. Underfeeding can result from cessation of enteral feeds for procedures and airway management, and for perceived gastrointestinal intolerance. We investigated the adequacy of nutritional intake in mechanically ventilated patients. Design: Calorie needs in adults mechanically ventilated for at least 3 days were calculated using PENN State 2002 equation or 14 kcals/kg (for BMI 30) and were compared against actual caloric intake from all sources to determine cumulative energy balance. Major Findings/Research Outcome: 1) Patients received an average of 44% of caloric needs during their stay in the ICU. The range was 0% to 98% of needs being met. 2) 36% of patients were started on enteral feeds within 48 hours of admission to the ICU. 3) Caloric decits ranged from 285 calories to 14,047 calories during the ICU stay, with an average decit of 6175 calories. No patients had a positive caloric balance. Multiple factors contributed to these results including NPO at midnight for surgery, slow initiation and/or advancement of feedings, and inconsistent withholding of enteral feeds for high residuals. Dietitians should identify practices that may impede the delivery of nutrition support at their facilities and develop interventions to improve this delivery. This may include addressing protocols for holding enteral feeds for a predetermined amount of time prior to elective surgery, or establishing thresholds for cessation of enteral feeds based on gastric residuals. Funding Disclosure: None

Physical Activity Duration and Steps Are Associated with Lower Total and Low Density Lipoprotein Cholesterol in Overweight Girls, but Not Boys Author(s): A. E. Mathews,1 S. Foss,1 D. Janicke2; 1Food Science and Human Nutrition, University of Florida, Gainesville, FL, 2Clinical Health and Health Psychology, University of Florida, Gainesville, FL Learning Outcome: To understand the role of physical activity duration and intensity on markers of cardiovascular disease in overweight children. Physical activity (PA) is associated with long term weight maintenance and lower risks of chronic diseases such as cardiovascular disease and obesity. The specic effect of PA on individual markers of chronic disease in overweight and obese children is poorly understood. The Family Lifestyle Intervention Program is an ongoing research study evaluating the effect of a family-based lifestyle intervention on nutrition, PA, BMI, and markers of cardiovascular disease in children who are overweight or at risk for overweight (85% height/weight on appropriate growth chart) and receiving Medicaid benets. Children, 7-12 years old (n35, mean age 10.02, mean BMI 29.736.4) underwent measures of height, weight, and blood pressure at baseline. Blood lipids (total cholesterol (TC), HDL-C, LDL-C, and triglycerides) were evaluated via a point-of-service analyzer. To objectively evaluate PA, children wore a multi-axis accelerometer (Sensewear WMS, Bodymedia) for an average of 3 days. Physical activity data was tabulated as average daily steps and minutes of moderate/vigorous intensity PA ( 3 METs). Average steps/day was 11,6064266 and 11,3004457.6 and minutes of moderate/vigorous PA was 143.9113.5 and 161.3112.1 for girls and boys respectively. Steps were inversely related to BMI (r0.49, p.01), TC (r.48, p.01), and LDL-C (r.56, p.01) for girls, but not boys. PA duration was associated with a lower BMI (r.42, p.02) for boys and a lower TC (r.72, p.01) and LDL-C (r.56, p.01) for girls. This suggests that both number of steps and PA intensity may have a more signicant impact on blood lipids in overweight girls than boys. Funding Disclosure: State of Florida, Agency for Health Care Administration

Gluten-Free and Casein-Free Diets as a Form of Alternative Treatment for Autism Spectrum Disorders Author(s): G. L. Washnieski, C. Seaborn, C. Schmidt, R. Nyland; University of Wisconsin-Stout, Menomonie, WI Learning Outcome: The use of gluten-free and casein-free diets may have impacted the behavior of the children with autism spectrum disorders in this study. The diagnosis for autism spectrum disorders (ASD) is not based on a clear cut test or examination, and there is currently no cure. The gluten-free/casein-free (GFCF) diet is a common alternative intervention used for ASD management. The purpose of this study was to determine the knowledge and perceptions of parents of children with ASD regarding the GFCF diet when used as a form of alternative treatment. Through the use of surveys, food records, and behavioral evaluations, the barriers to initiating and maintaining the diet, accuracy of implementation, perceived behavioral benets, and parent preferences for receiving reliable information were evaluated. Participants who have used the diets were placed in the diet group (n11), and those who have not were in the nondiet group (n17). Signicant differences were found in behavior evaluations between the diet and nondiet groups in the speech, social, sensory, and health behavior categories (Chi Square p0.001). Participants in the nondiet group reported using drug treatment signicantly more than the diet group (p0.05). This study suggests that GFCF diets can impact the behavior of children with ASD positively, and highlights the importance of including a nutritional professional on the childs health care team. Funding Disclosure: UW-Stout Research Services

Journal of the AMERICAN DIETETIC ASSOCIATION / A-39