Wendy Barth

Nutrition
Research Article Critique
November 2, 2016

Lewis, C. W., Frongillo, E. A., & Roe, D. A. (1995). Drug-Nutrient Interactions in Three Long-
Term-Care Facilities. Journal of the American Dietetic Association, 95(3), 309 315.
doi:10.1016/s0002-8223(95)00079-8

My Abstract
The research topic selected for presentations was Nutrient-Drug Interactions. When

researching different studies and articles, it was difficult to find and actual conducted research

article to critique. Most of the information found were books with information on Drug-Nutrient

Interactions involved with patient care and chemical reactions. The research article found and

used for this assignment was a study on drug-nutrient interactions in three long-term-care

facilities.

Evaluate the title

The title of the research paper selected is, Drug-nutrient interactions in three long-term-

care facilities. The title is both clear and concise on what research was conducted. It portrays

exactly what content the research article has to offer and states easily what it is about.

Abstract

The abstract provides a small insight on the objective, design, setting, subjects,

measurements, results, and conclusion of the research article. It pulled me in by stating data right

away and gave a sufficient overview of the information in the research paper. The abstract gives

the purpose of the paper in the objectives. The methodology is within the design, setting,
subjects, and measurements of the abstract, and it has a brief summary of both the results and

conclusion of the research conducted.

Introduction

The controlling idea of the study is to assess the risk of drug-nutrient interactions (DNIs)

in three long term care facilities. It gives background on how drug-nutrient interactions are

events and outcomes that happen because of physical, chemical, physiologic, or physiopathology

relationships between drugs and nutrients. It goes on to state that this study is significant because

limited information exists on the incidence of these interactions within populations and how it

has a growing concern. It is very neatly written and organized in a clear and concise manner.

Other types of research studies that were revived include: The Therapeutic significance of

drug-nutrient interactions in the elderly by Pharmacol Rev., and Drug-food interaction

counseling in The 1994 Joint Commission Accreditation Manual for Hospitals. Volume: 1. The

review addresses that there isnt much information on this topic. The review is somewhat

confusing to read because it has a lot of larger conceptual topics and isnt clear which it is

referring to. The reviewed articles are relevant but are from the 1990s and later. All the facts are

parenthetically cited with numbers in parenthesis referring to the reference page at the end of the

article. This makes all the facts provided easily found in the research done to put this article

together. A majority of the cited sources are not within five years of the publication date of this

article, whereas most is within ten years. The cited sources seem credible since they are all

pulled from other studies and scientific journals. The review does lead logically to the objective

of the research conducted.

Research Question/Hypothesis/Objective
 The research question is not clearly stated nor is there a hypothesis that can be easily

found. Instead it states, The goals of our research were to assess the risk of drug-nutrient

interactions in three long-term-care facilities in central New York State, to determine the need for

intervention, and to develop strategies for prevention of these interaction. The goal ties into the

research of the paper because data is analyzed due to the objective stated.

Methodology

The research was conducted by selecting patients from three long-term-care facilities that

provide skilled and intermediate levels of care. The study design was approved by the

administrative boards of each of the facilities and by the Human Subjects Review Committee at

Cornell University. Fifty-Three patients were selected from each facility opting out patients with

terminal conditions and those admitted for less than 6 months before the study. All patients from

the skilled nursing units that fit the criteria were selected in facilities A and B. Facility C had a

random sample of patients selected from each of the four skilled nursing units. This effectively

shows how the samples were selected.

In data collection, use of a medical record abstraction form designed for this study,

detailed clinical and therapeutic data were collected from each subject's medical record by an

investigator. All medications and vitamin and mineral supplements administered during the

month, the dosage, and administration schedule were recorded. This shows that the design was

described in detail and all the variables were identified, along with data-gathering information.

There was no mention of threats to validity nor mentions of flaws to the study. An algorithm was

developed and the authors designed and pilot-tested an algorithm for the assessment of potential

DNIs. Potential DNIs were defined as a temporal association between the administration of a

drug and the administration of a nutrient or food (or lack thereof) where an adverse effect is
known to occur with the association. The algorithm consists of eight sets of branched questions

that correspond to eight classes of DNIs which will be provided in the table portion. The study

states, Data were analyzed with the Statistical Analysis System (version 5, 1985, SAS Institute,

Gary, NC). Descriptive statistics on mean number of medications and potential DNIs per patient

were generated for each facility for each month of the study period. Analysis of variance

established significance of association between the mean number of drugs per patient per month

and the mean number of potential DNIs per patient per month in each unit for the 6-month study

period. This shows that the data analysis procedures are clearly stated for this study.

Summary of results

The results section starts out by restating the total number of subjects (158) and how

many were from each A, B, and C facilities. The it goes on to state the characteristics of the

result tables. The results directly tied into the objective given at the beginning of the research

article by assessing the risks of DNIs. The tables show the different interacts at the three

facilities and the type of patients studied. Each table has a clear description of what was analyzed

and text to correlate with the results and further explain the information. The text in results are

both clear and concise and the statistical data is accurately interpreted.

Tables
Sex and Age Characteristics of Study Population
Most Frequently Reported Diseases in each facility at the onset of the Study

Frequency of Consumption of the Most Commonly Administered Drug During the First Month of
Study

Mean Incidence and Rate of Prevention per month of Most Frequent Potential Drug-Nutrient
Interactions (DNIs)
Discussion and Conclusion
The main conclusion on this research is that the facilities that gave greater amounts of

drugs to the patients in an incorrect manner had a greater risk of drug-nutrient interactions. The

procedure and findings were precisely stated in the discussion. The findings were justified by the

tables shown above. The discussion tied back to the literature review by stating that although not

many studies have been done on this population there was still a successful outcome in data to

help fix the problem at hand. The discussion section goes into greater detail on other studies

conducted and how this study correlates. Livingston and Reeves, Varma, and Petrick and

Kleinmann were all studies that were discussed and compared with results found in this

particular study. The author states, We found a direct linear relationship between the number of

drugs a patient was taking and the number of DNIs for which a patient was at risk. This finding

suggests that patients who consume more drugs are at increased risk for DNIs. Research has

shown that of all the factors that influence susceptibility to adverse drug reactions, multiple drug

use has been most strongly and consistently associated. This conclusion was based off of the

sufficient data. Implications that can be drawn along with implications for professional practice

in future research are that intervention can be aimed at decreasing the number of medications

consumed by patients in long-term-care facilities and may be beneficial in decreasing risk for

DNIs. Some investigators expressed concern that these patients were receiving more drugs than

are necessary which can be analyzed and fixed by the doctor or dietitian at the facility.

References

Most references in the article were primary sources being medical journal publications

from doctors. A total of 40 different citations were offered by the study. The sources range from

2-12 years of the publication data, which shows some are much more resent than others. The
paper did indeed have a sufficient number of sources to provide good concrete evidence.

Whenever a new idea or fact was offered the citation number corresponding to a citation in the

references area was provided. The references were trustworthy due to mostly being pulled from

medical journals and studies conducted at different colleges.

My Conclusion

From this research article on DNIs, I learned that patients that consume multiple

medications on a daily basis, are at a greater risk for certain DNIs. The most common DNIs

found in the study were GI interactions. The most common kind of interaction affecting

electrolytes varied from facility to facility. The conclusion from the article states, The impact on

a population of adverse drug reactions that affect nutrition status has not been explored

adequately. We assessed the incidence of potential DNIs in patients residing in long-term-care

facilities. Results of our study indicate that these patients, who are primarily elderly and

chronically ill and who consume multiple medications on a daily basis, are at notable risk for

certain DNIs.

From the actual critical evaluation steps, I learned how to properly asses a research article

to determine whether it is valid or not along with if its sources are trustworthy. I also learned

how to set up a research article based on steps and questions to ask ones self to make sure the

paper is clear and concise in both text and data analysis.

Applies to Me

This research applies to me most by my future career. The implementation of education,

administrative, and monitoring efforts to decrease DNIs can be planned and made possible by the

facilities Dietitian. In the study, it states, Dietitians can play an important role in educating other
health professionals and in designing policies to monitor and prevent DNIs. It also takes about

how comprehensive information on DNIs needs to be incorporated into dietetics undergraduate

and continuing education curriculums so that dietitians will be prepared to educate other health

professionals about DNIs and to design and prevent their occurrence in different facilities. With

further education, I hope to be able to effectively help health care professionals and their patients

with this issue in my future career. I choose this topic because I enjoy learning about how

different substances interact with the body and I feel I have a better understanding of that now

though learning about Drug-Nutrient Interactions.