An Observational Study of Adults With Down Syndrome Eating Independently.

An Observational Study of Adults with Down Syndrome Eating Independently.

Dysphagia. 2013 Jul 17;
Smith CH, Teo Y, Simpson S

This study examined the oral feeding in a group of adults with Down syndrome. None of the 23 participants in the study had reported oral feeding difficulties, and all independently ate a full oral diet (food and liquids). Observations were made during the consumption of one meal and one drink. The eating and drinking behaviours observed included eating rate and ability to keep food in the mouth, and these were considered in conjunction with oral and pharyngeal phase skills and difficulties. Coughing, an overt sign of possible aspiration with its attendant risk of upper respiratory tract infection, was seen in 56.5 % of participants. In addition, several of the observed oral feeding behaviours of this group of individuals may be socially unacceptable and therefore likely to compromise quality of life. A number of behaviours with implications for both health and quality of life may be amenable to simple behaviour modification or to changes to the environment. Further study into the causes of these oral feeding difficulties, their implications for social integration, and their potential remediation is required. HubMed – eating

The efficacy of protected mealtimes in reducing mealtime interruptions and improving mealtime assistance in adult inpatients in an Australian hospital.

Eur J Clin Nutr. 2013 Jul 17;
Huxtable S, Palmer M

Background/Objectives:A Protected Mealtimes Programme (PMP) encourages staff, volunteers and visitors to assist patients and cease non-urgent clinical activity during mealtimes. Given the limited evidence available establishing the efficacy of PMP, we compared mealtime interruptions, mealtime assistance received and nutrient intakes before and after PMP implementation in adult inpatients on acute wards.Subjects/Methods:Data collected on patients at main meals before and after PMP implementation included the following: diet code, level of assistance required and received and by whom, time available to consume the meal, position of the patient and tray during eating, type of interruption and by whom and proportion of foods and drinks consumed. Outcomes pre- and post-PMP implementation were compared using ?(2), independent samples t-tests and logistic regression analyses.Results:Over two years, 1632 inpatient mealtime observations were conducted (65 (18) years, 51% M). Similar proportions of patients received mealtime assistance when required (?84%, P=0.928). Feeding assistance nearly doubled post-PMP implementation (15-29%, P=0.002). Interruptions by nursing staff increased by 8% post-PMP implementation (P<0.001) and represented 61% of all interruptions. Interruptions were less likely to occur pre-PMP implementation (odds ratio, 0.403, 95% confidence interval, 0.301-0.539). Mealtime energy and protein intakes were not changed post-PMP (P=0.979, P=0.482, respectively).Conclusions:The PMP increased nursing staff availability at mealtimes and feeding assistance, but also increased mealtime interruptions. This may explain the lack of change in patient energy and protein consumption. Strategies promoting adherence with PMP implementation, such as nurse ward champions or nursing staff driving PMP implementation, may be required to maximise the benefits of protected mealtimes.European Journal of Clinical Nutrition advance online publication, 17 July 2013; doi:10.1038/ejcn.2013.126. HubMed – eating

Effects of a Physical Activity and Healthy Eating Intervention To Reduce Stroke Risk Factors in Older Adults.

Prev Med. 2013 Jul 13;
Silva-Smith A, Fleury J, Belyea M

To evaluate the effects of a theory-based physical activity and healthy eating intervention aimed at reducing stroke risk factors among overweight/obese and sedentary older adults.Between 12/2009-1/2011, participants (n=69) were randomly assigned to an 8-week group motivational intervention or biweekly newsletters by mail. Physical activity (blinded pedometer, 7-day recall) body composition, theoretical mediator, and dietary (24-hour recall) variables were measured at pre-test and post-test. The physical activity and dietary outcomes are reported.For outcome measures, the follow-up was 90% for the intervention group (n=29) and 91% for the control group (n=34) for this sample. Statistically significant differences in the 7-day physical activity self-report were noted at post-test in the intervention group. The dietary measures were not statistically significant at post-test; however, the intervention group increased the quantity of vegetable servings.Limited efficacy testing was supported for a combined physical activity-dietary intervention, framed by a wellness-motivation theory, and designed to reduce stroke risk factors in older adults who are sedentary and overweight/obese. Limitations were identified and recommendations for additional research provided. HubMed – eating

Water-Soluble Vitamins in People with Low Glomerular Filtration Rate or On Dialysis: A Review.

Semin Dial. 2013 Jul 17;
Clase CM, Ki V, Holden RM

People with low glomerular filtration rate and people on dialysis are spontaneously at risk for vitamin deficiency because of the potential for problems with decreased appetite and decreased sense of smell and taste, leading to decreased intake, and because decreased energy or decreased cognitive ability results in difficulties in shopping and cooking. Imposed dietary restrictions because of their renal dysfunction and because of comorbidities such as hypertension and diabetes exacerbate this problem. Finally, particularly for water-soluble vitamins, loss may occur into the dialysate. We did not identify any randomized trials of administering daily doses close to the recommended daily allowances of these vitamins. In people who are eating at all, deficiencies of B5 and B7 seem unlikely. It is unclear whether supplements of B2 and B3 are necessary. Because of dialyzability and documented evidence of insufficiency in dialysis patients, B1 supplementation is likely to be helpful. B6, B9, and B12 are implicated in the hyperhomocysteinemia observed in patients on dialysis. These vitamins have been studied in combinations, in high doses, with the hope of reducing cardiovascular outcomes. No reductions in patient-important outcomes were seen in adequately powered randomized trials. Because of their involvement in the homocysteine pathway, however, supplementation with lower doses, close to the recommended daily allowances, may be helpful. Vitamin C deficiency is common in patients on dialysis who are not taking supplements: low-dose supplements are warranted. Vitamins for dialysis patients contain most or all of the B vitamins and low-dose vitamin C. We are not aware of any medical reasons to choose one over another. HubMed – eating

DSM-5: The Eating Disorders Workgroup
An overview of the DSM-5 Eating Disorders Work Group. Columbia psychiatry’s Dr. B. Timothy Walsh, chair of the DSM-5 Eating Disorders Work Group and Dr. Evel…