All Posts tagged based

Menu Review for Juvenile Justice

Client

One of Australia’s leading juvenile justice services providing secure and safe care of up to 500 young offenders.

Needs

Review adequacy of summer and winter menus to address concerns raised to the State by the public.
Ensure compliance with Nutrient Reference Values for Australia and New Zealand
Ensure compliance with Dietary Guidelines for Children and Adolescents in Australia
Ensure compliance with Standards for Juvenile Custodial Facilities

Overview

Review of custodial health findings in various State jurisdictions around Australia and overseas.
Computer based macro and micro nutrient analysis of menus and individual recipes including protein, fat, carbohydrate and protein percentages
Computer based energy analysis of menus and individual recipes
Analysis of menus against nutrient reference values and appropriate recommendations.
Analysis of menus against dietary guidelines and appropriate recommendations
Analysis of food variety and appropriate recommendations
Analysis of special dietary needs and appropriate recommendations
Analysis of food choice and satisfaction and appropriate recommendations
Executive presentation

 

 

More

Your Risk for Rheumatoid Arthritis

A popular pastime for many older people is to try and figure out their chances of getting one ailment or another. Mayo Clinic researchers have simplified it – they have figured out the lifetime risk of developing rheumatoid arthritis and six other autoimmune rheumatic diseases for both men and women. “We estimated the lifetime risk for rheumatic disease for both sexes, something that had not been done before — separately or collectively,” says Cynthia Crowson Mayo Clinic biostatistician and first author. “Prevalence and incidence rates existed, but prevalence figures underestimate individual risk and incidence rates express only a yearly estimate.”

{qtube vid:=ylPX1I_qYhE}

The researchers were looking for an accurate basis to offer an easy-to-understand average risk over a person’s lifetime, knowing that risk changes at almost every age. They used data from the Rochester Epidemiology Project, a long-term epidemiology resource based on patients in Olmsted County, Minn. The cohort of 1179, consisted of patients diagnosed between 1955 and 2007, allowed the team to extrapolate the nationwide estimates.

The adult lifetime risk in the United States of having some kind of inflammatory autoimmune disease is 8.4 percent for women and 5.1 percent for men. Based on year 2000 population figures, that means one woman in 12 and one man in 20 will develop one of the conditions in their lifetime. The authors consider that a substantial risk and say their findings should encourage more research on the value of early diagnosis and intervention for people with increased genetic risk of arthritis. They hope the new figures will help in counseling patients and in fundraising efforts to find improved treatments.

The research was supported by the National Institutes of Health.

 

More

Not All Infant Formulas Are Alike

New findings from the Monell Center reveal that weight gain of formula-fed infants is influenced by the type of formula the infant is consuming. The findings have implications related to the infant’s risk for the development of obesity, diabetes and other diseases later in life. “Events early in life have long-term consequences on health and one of the most significant influences is early growth rate,” said study lead author Julie Mennella, Ph.D., a developmental psychobiologist at Monell. “We already know that formula-fed babies gain more weight than breast-fed babies. But we didn’t know whether this was true for all types of formula.”

While most infant formulas are cow’s milk-based, other choices include soy-based and protein hydrolysate-based formulas. Protein hydrolysate formulas contain pre-digested proteins and typically are fed to infants who cannot tolerate the intact proteins in other formulas. In adults, pre-digested proteins are believed to act in the intestine to initiate the end of a meal, thus leading to smaller meals and intake of fewer calories. Based on this, the authors hypothesized that infants who were feeding protein hydrolysate formulas would eat less and have an altered growth pattern relative to infants feeding cow’s milk-based formula.

In the study, published online in the journal Pediatrics, infants whose parents had already decided to bottle-feed were randomly assigned at two weeks of age to feed either a cow’s milk-based formula (35 infants) or a protein hydrolysate formula (24 infants) for seven months. Both formulas contained the same amount of calories, but the hydrolysate formula had more protein, including greater amounts of small peptides and free amino acids. Infants were weighed once each month in the laboratory, where they also were videotaped consuming a meal of the assigned formula. The meal continued until the infant signaled that s/he was full.

Over the seven months of the study, the protein hydrolysate infants gained weight at a slower rate than infants fed cow milk formula. Linear growth, or length, did not differ between the two groups, demonstrating that the differences in growth were specifically attributable to weight. “All formulas are not alike,” said Mennella. “These two formulas have the same amount of calories, but differ considerably in terms of how they influence infant growth.”

When the data were compared to national norms for breast-fed infants, the rate of weight gain of protein hydrolysate infants was comparable to the breast milk standards; in contrast, infants fed cow’s milk formula gained weight at a greater rate than the same breast milk standards. Analysis of the laboratory meal revealed the infants fed the protein hydrolysate formula consumed less formula during the meal. “One of the reasons the protein hydrolysate infants had similar growth patterns to breast-fed infants, who are the gold standard, is that they consumed less formula during a feed as compared to infants fed cow’s milk formula” said Mennella. “The next question to ask is: Why do infants on cow’s milk formula overfeed?”

The findings highlight the need to understand the long-term influences of infant formula composition on feeding behavior, growth, and metabolic health. Future studies will utilize measures of energy metabolism and expenditure to examine how the individual formulas influence growth, and how each differs from breastfeeding. Also contributing to the study, which was funded by the National Institute of Child Health and Human Development, were Monell scientists Gary Beauchamp and Alison Ventura.

More

Meditation reduces the emotional impact of pain

The study, to be published in the journal Pain, found that particular areas of the brain were less active as meditators anticipated pain, as induced by a laser device. Those with longer meditation experience (up to 35 years) showed the least anticipation of the laser pain.

Dr Brown, who is based in the University's School of Translational Medicine, found that people who meditate also showed unusual activity during anticipation of pain in part of the prefrontal cortex, a brain region known to be involved in controlling attention and thought processes when potential threats are perceived.

He said: “The results of the study confirm how we suspected meditation might affect the brain. Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse.”

Dr Brown said the findings should encourage further research into how the brain is changed by meditation practice. He said: “Although we found that meditators anticipate pain less and find pain less unpleasant, it's not clear precisely how meditation changes brain function over time to produce these effects.

“However, the importance of developing new treatments for chronic pain is clear: 40% of people who suffer from chronic pain report inadequate management of their pain problem.”

In the UK, more than 10 million adults consult their GP each year with arthritis and related conditions. The estimated annual direct cost of these conditions to health and social services is £5.7 billion.

Study co-author Professor Anthony Jones said: “One might argue that if a therapy works, then why should we care how it works? But it may be surprising to learn that the mechanisms of action of many current therapies are largely unknown, a fact that hinders the development of new treatments. Understanding how meditation works would help improve this method of treatment and help in the development of new therapies.

“There may also be some types of patient with chronic pain who benefit more from meditation-based therapies than others. If we can find out the mechanism of action of meditation for reducing pain, we may be able to screen patients in the future for deficiencies in that mechanism, allowing us to target the treatment to those people.

More

Fad Diets:What you may be missing

Food-specific diets rely on the myth that some foods have special properties that can cause weight loss or gain. But no food can. These diets don't teach healthful eating habits; therefore, you won't stick with them. Sooner or later, you'll have a taste for something else – anything that is not among the foods you've been “allowed” on the diet.

The popular high-protein, low-carbohydrate diets are based on the idea that carbohydrates are bad,
that many people are “allergic” to them or are insulin-resistant, and therefore gain weight when they eat them. The truth is that people are eating more total calories and getting less physical activity, and that is the real reason they are gaining weight. These high-protein, low-carbohydrate diets tend to be low in calcium and fiber, as well as healthy phytochemicals (plant chemicals).

Some authors of these fad diets advise taking vitamin-mineral supplements to replace lost nutrients. However, supplements should “bridge the gap” in healthy eating and not be used as a replacement for nutrient-rich foods. Also, the authors of high-protein, low-carbohydrate diets advocate taking advantage of ketosis to accelerate weight loss. Ketosis is an abnormal body process that occurs during starvation due to lack of carbohydrate. Ketosis can cause fatigue, constipation, nausea, and vomiting. Potential long-term side effects of ketosis include heart disease, bone loss, and kidney damage.

Successful weight loss (losing weight and keeping it off for at least five years) is accomplished by making positive changes to both eating habits and physical activity patterns.

How can you spot a fad diet?

Weight-loss advice comes in literally hundreds of disguises. Most often the “new” and “revolutionary” diets are really old fad diets making an encore appearance. Examples of fad diets include those that:

  • tout or ban a specific food or food group
  • suggest that food can change body chemistry
  • blame specific hormones for weight problems

Ten Red Flags That Signal Bad Nutrition Advice:

  • Recommendations that promise a quick fix
  • Dire warnings of dangers from a single product or regimen
  • Claims that sound too good to be true
  • Simplistic conclusions drawn from a complex study
  • Recommendations based on a single study
  • Dramatic statements that are refuted by reputable scientific organizations
  • Lists of “good” and “bad” foods
  • Recommendations made to help sell a product
  • Recommendations based on studies published without peer review
  • Recommendations from studies that ignore differences among individuals or groups

Source: American Dietetic Association

More

No Clear Criteria for Diagnosing Food Allergies

Food allergies, by some accounts, affect about 4 percent of adults and 5 percent of children under the age of 6 in the United States, though this study raises questions about the reliability of such figures.

Food allergies can cause a variety of problems, ranging from mild skin rashes or nausea to a life-threatening, whole-body reaction known as anaphylaxis. The allergies can also have serious effects on patients' social interactions, school and work attendance, family economics and overall quality of life. “It's a life-defining diagnosis in a way,” said Chafen.

The National Institute of Allergy and Infectious Diseases is working on new clinical practice guidelines and, as part of its efforts, enlisted Chafen and her colleagues to review the current evidence on food allergies.

The researchers started their work by sifting through thousands of scientific papers, published between 1988 and 2009, that focused on the four foods — milk, eggs, fish and peanut and tree nuts — responsible for more than half of all allergies. They ultimately reviewed 72 studies, including one meta-analysis on prevalence, 18 studies on diagnosis, 28 studies on management, and four meta-analyses and 21 additional studies on prevention.

When examining the literature, the researchers found there was no universal definition of “food allergy,” in spite of NIAID's defining it as an “adverse immune response” that is “distinct from other adverse responses” such as a food intolerance. In fact, 82 percent of the studies provided their own definition of food allergy.

“This validates the idea that there exists a great deal of complexity and confusion in the field of food allergy, even at the level of the medical literature,” said co-author Marc Riedl, MD, MS, section head of clinical immunology and allergy at UCLA.

Along the same lines, there was a lack of uniformity for criteria in making a diagnosis. The current gold standard is the food challenge, during which a physician gives a patient a sample of the suspected offending food, sometimes in capsule form, and then monitors for allergic reaction. However, this test requires specialized personnel, is expensive and has a risk of anaphylaxis. Office-based tests were used to diagnose many patients; these include a skin-prick test, during which a dilute extract of the potential allergen is placed on the skin, and a blood test that determines the presence of food-specific allergic antibodies known as IgE.

As the researchers discuss in their paper, the concern with the latter two tests is that they're not definitive: Patients with non-specific symptoms, such as a rash or digestive troubles, and positive skin-prick or blood tests actually have less than a 50 percent chance of having a food allergy. In order to make a proper diagnosis, they pointed out, physicians need to evaluate the data within the context of a patient's history and have a great understanding of symptoms consistent with true food allergy.

What this means, then, is there is a potential for the overdiagnosis of food allergy.

“I frequently see patients in my clinical practice who have food intolerance, but have previously had inadequate or inappropriate evaluation and been told they have a 'food allergy',” said Riedl. “This causes a great deal of unnecessary anxiety and concern for the patient.”

Previous studies have tried to determine whether the skin-prick or blood test is superior over the other, but in reviewing the evidence, Chafen and her colleagues found “no statistical superiority in either test.” They also found generally inconclusive results from 10 previous studies in which the tests were combined, in an effort to improve diagnostic accuracy.

“I was very surprised,” said Chafen. “I'm a general internist and I thought diagnostic strategies were more-studied.”

In terms of treatment, Chafen said expert opinion is that an elimination diet — having the patient stop consuming the food that causes the allergic reaction — is the most common. Although the approach is a common-sense one (“If a patient breaks out in hives repeatedly after drinking milk, it's your instinct as a physician to say, 'Don't drink milk,'” Chafen said), the researchers found the treatment hasn't been well-studied.

It would be unethical to conduct controlled studies of elimination diets for patients with serious, life-threatening allergic reactions, but as pointed out in the paper, there are few studies of this approach on patients with relatively minor symptoms.

“In these instances, the benefits of an elimination diet are uncertain based on published evidence and potential benefits need to be weighed against the potential nutritional risks of such a diet, particularly in children,” the researchers wrote.

Chafen and her colleagues also found that immunotherapy, a treatment in which the body's immune system is altered by administering increasing doses of the allergen over time, appeared to be effective at eliminating symptoms in the short term. Immunotherapy isn't a licensed method for allergy treatment, but the researchers urged more study on its long-term effect and safety.

In all, the researchers concluded, the food-allergy field is in need of uniformity in the criteria for what constitutes an allergy and a set of evidence-based guidelines upon which to make this diagnosis. NIAID, which put together an expert panel and has reviewed the group's analysis, is planning to finalize such guidelines later this summer.

As for Chafen, who sees patients with potential food allergies, these findings have encouraged her to rely more on specialists to help clinch a diagnosis. “People need to be seen by someone with a deep understanding of diagnostic tests and criteria,” she said. “The distinction between food intolerance and food allergy is really important.”

The study was funded by NIAID. Other Stanford authors on the study are Dena Bravata, MD, a PCOR affiliate; and Vandana Sundaram, MPH, assistant director of research for CHP/PCOR. Paul Shekelle, MD, PhD, with the RAND Corp.'s Southern California Evidence-Based Practice Center and the West Los Angeles VA Medical Center, is the senior author.

More

Abdominal Fat in Middle Age Associated with Greater Risk of Dementia

Researchers from Boston University School of Medicine determined that excess abdominal fat places otherwise healthy, middle-aged people at risk for dementia later in life. Preliminary findings suggest a relationship between obesity and dementia that could lead to promising prevention strategies in the future. Results of this study are published early online in Annals of Neurology, a journal of the American Neurological Association.

A 2005 World Health Organization (WHO) report estimated that 24.3 million people have some form of dementia, with 4.6 million new cases annually. Individuals with dementia exhibit a decline in short-term and long-term memory, language processing, problem solving capabilities, and other cognitive function. Clinical diagnosis of dementia is made when two or more brain functions are significantly impaired. Symptoms of dementia can be attributed to irreversible causes such Alzheimer's disease, vascular dementia, and Huntington's disease, or caused by treatable conditions such as brain tumor, medication reaction, or metabolic issues.

For the current study, Sudha Seshadri, M.D. and colleagues recruited participants from the Framingham Heart Study Offspring Cohort. The sample included 733 community participants who had a mean age of 60 years with roughly 70% of the study group comprised of women. Researchers examined the association between Body Mass Index (BMI), waist circumference, waist to hip ratio, CT-based measures of abdominal fat, with MRI measures of total brain volume (TCBV), temporal horn volume (THV), white matter hyperintensity volume (WMHV) and brain infarcts in the middle-aged participants.

“Our results confirm the inverse association of increasing BMI with lower brain volumes in older adults and with younger, middle-aged adults and extends the findings to a much larger study sample,” noted Dr. Seshadri. Prior studies were conducted in cohorts with less than 300 participants and the current study includes over 700 individuals.

“More importantly our data suggests a stronger connection between central obesity, particularly the visceral fat component of abdominal obesity, and risk of dementia and Alzheimer's disease,” Dr. Seshadri added. The research showed the association between VAT and TCBV was most robust and was also independent of BMI and insulin resistance. Researchers did not observe a statistically significant correlation between CT-based abdominal fat measures and THV, WMHV or BI.

“Our findings, while preliminary, provide greater understanding of the mechanisms underlying the link between obesity and dementia,” concluded Dr. Seshadri. “Further studies will add to our knowledge and offer important methods of prevention.”

Source: Stéphanie Debette, Alexa Beiser, Udo Hoffmann, Charles DeCarli, Christopher J. O'Donnell, Joseph M. Massaro, Rhoda Au, Jayandra J. Himali, Philip A. Wolf, Caroline S. Fox, Sudha Seshadri. Visceral Fat is Associated with Lower Brain Volume in Healthy Middle-Aged Adults. Annals of Neurology, 2010

More

Vitamin K tied to lower cancer risk

In the current study, vitamin K2 — which study participants most frequently got through cheese — was linked to the odds of developing or dying from cancer, whereas vitamin K1 was not.

The findings are based on data from 24,340 German adults who were between the ages of 35 and 64, and cancer-free at the outset. The researchers estimated the participants' usual vitamin K intake based on a detailed dietary questionnaire. Over the next decade, 1,755 participants were diagnosed with colon, breast, prostate or lung cancers, of whom 458 died during the study period.

In general, the researchers found, the one quarter with the highest intakes of vitamin K2 were 28 percent less likely to have died of any one of the cancers than the one-quarter of men and women with the lowest intakes of the vitamin. That was with factors like age, weight, exercise habits, smoking and consumption of certain other nutrients, like fiber and calcium, taken into account.

Of the one-quarter of study participants who got the least vitamin K2, 156 — or 2.6 percent — died of one of the four cancers. That was true of 1.6 percent of participants with the highest intakes of the vitamin from food.

When Linseisin's team looked at the cancer types individually, there was no clear link between either form of vitamin K and breast cancer or colon cancer. However, greater consumption of vitamin K2 was linked to lower risks of developing or dying from lung cancer — a disease for which smoking is the major risk factor — or of developing prostate cancer.

Of the one-quarter of study participants with the lowest vitamin K2 intakes, 47 — or 0.8 percent — developed lung cancer, versus 0.4 percent of the one-quarter who got the most vitamin K2 in their diets. When it came to prostate cancer, there were 111 cases among the one-quarter of men with the lowest vitamin K2 intakes, and 65 cases in the group with the highest consumption.

In theory, vitamin K itself could offer some protection against cancer. It's often used to counteract too-high doses of blood thinners, although this does not have an obvious link to cancer. In lab research, however, Linseisin and his colleagues point out, the vitamin has been shown to inhibit cancer cell growth and promote apoptosis — a process by which abnormal cells kill themselves off.

But whether vitamin K intake itself is responsible for the lower cancer risks in this study is unclear, according to the researchers. One limitation is that they estimated vitamin K intake based on participants' reported eating habits; most of their vitamin K came from eating cheese, and it's possible, Linseisin and his colleagues note, that some other components of that food are related to cancer risk.

Future studies, the researchers say, should measure people's blood levels of vitamin K and look at the relationship of those levels with cancer risks.

SOURCE: American Journal of Clinical Nutrition

More

When and how to make a referral

A referral to Nastaran Habibi should be made when your patient needs more intensive dietary, nutritional and lifestyle behavior education than you can provide in your office environment. Nastaran can help particularly when the patient is in the preparation, action or relapse stages of change.

A consultation generally includes a diet and lifestyle assessment, and nutrition education and counselling. Nastaran will review your patient’s medical and social status, including biochemistry and othe relevant test results, dietary and family history and home environment. In addition she will take anthropometric measurements and collect information on the patient’s individual food preferences and cultural, socio-economic and lifestyle needs. Taking into account the patient’s own goals, knowledge, skills and access to resources, Nastaran will custom design a program for your patient based on the principles of Medical Nutrition Therapy. She integrates self-management training regarding information on nutrient content, food choices, and meal preparation based on each patient’s particular and unique circumstances. Initial appointments are more than 1 hour.

What happens next:

  • You will receive a formal report assessing your patient’s nutritional, physical activity and lifestyle status including Nastaran’s recommendations for improvement, possible barriers to success and guidelines for evaluating progress.
  • During the 45-90 minute follow-up visits, Nastaran will review your patient’s progress, provide further education, encourage continued adherence to the plan and identify any obstacles to success.

In order for your patient to qualify for a Medicare rebate, referral must be through an Enhanced Care Plan. Referrals outside Medicare will still qualify for a Health Fund rebate.

More