Future doctors need more nutrition education

by Griffith University

Credit: Pixabay/CC0 Public Domain

Medical students need more support to increase their nutrition knowledge and skills before they graduate a Griffith University study has found.

17 november 2020--The five-year study published in the journal BMJ Nutrition, Prevention and Health, examined over 100 New Zealand medical students' self-reported nutrition knowledge at three time points during their medical training by asking them to complete the same survey at the end of year 2, year 4 and year 5 of their degree.

"While the students modestly increased their nutrition knowledge and skills between year 2 and year 4, the overall results were still very low,'' says lead author Associate Professor Lauren Ball from Menzies Health Institute Queensland.

"There was a clear desire for more nutrition education from all students. A key strategy to support healthy eating is to incorporate nutrition into healthcare service and doctors are expected to provide nutrition advice to patients to improve their diet when necessary. But to provide nutrition care, doctors require adequate nutrition knowledge, skills and attitudes to support the integration of such care into routine practice with patients."

Associate Professor Ball said it was recognized that graduating medical students lack nutrition knowledge and skills to actively support dietary behavior change in patients.

"This is the first study to describe how medical students' self-perceived nutrition competence changes over time during medical training. These results show that further supporting medical students to increase their knowledge and skills in this area is essential. While the study was conducted in New Zealand, Australian students face the same challenges as their counterparts across the ditch because medical programs are accredited by the same body, with identical mandatory components. Given the recognized link between nutrition and health, one approach to consider is making nutrition education compulsory for medical training."

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More information: Jennifer Crowley et al. How does self-perceived nutrition competence change over time during medical training? A prospective longitudinal observational study of New Zealand medical students, BMJ Nutrition, Prevention & Health (2020). DOI: 10.1136/bmjnph-2020-000080

Provided by Griffith University 

Is white or whole wheat bread 'healthier?' Depends on the person

This visual abstract shows the findings of Korem et al. who performed a crossover trial of industrial white or artisanal sourdough bread consumption and found no significant difference in clinical effects, with the gut microbiome composition remaining generally stable. They showed the glycemic response to bread type to be person specific and microbiome associated, highlighting the importance of nutrition personalization.

17 jun 2017--Despite many studies looking at which bread is the healthiest, it is still not clear what effect bread and differences among bread types have on clinically relevant parameters and on the microbiome. In the journal Cell Metabolism on June 6, Weizmann Institute researchers report the results of a comprehensive, randomized trial in 20 healthy subjects comparing differences in how processed white bread and artisanal whole wheat sourdough affect the body.
Surprisingly, the investigators found the bread itself didn't greatly affect the participants and that different people reacted differently to the bread. The research team then devised an algorithm to help predict how individuals may respond to the bread in their diets.
All of the participants in the study normally consumed about 10% of their calories from bread. Half were assigned to consume an increased amount of processed, packaged white bread for a week—around 25% of their calories—and half to consume an increased amount of whole wheat sourdough, which was baked especially for the study and delivered fresh to the participants. After a 2-week period without bread, the diets for the two groups were reversed.
Before the study and throughout the time it was ongoing, many health effects were monitored. These included wakeup glucose levels; levels of the essential minerals calcium, iron, and magnesium; fat and cholesterol levels; kidney and liver enzymes; and several markers for inflammation and tissue damage. The investigators also measured the makeup of the participants' microbiomes before, during, and after the study.
"The initial finding, and this was very much contrary to our expectation, was that there were no clinically significant differences between the effects of these two types of bread on any of the parameters that we measured," says Eran Segal, a computational biologist at the Weizmann Institute of Science and one of the study's senior authors. "We looked at a number of markers, and there was no measurable difference in the effect that this type of dietary intervention had."
Based on some of their earlier work, however, which found that different people have different glycemic responses to the same diet, the investigators suspected that something more complicated may be going on: perhaps the glycemic response of some of the people in the study was better to one type of bread, and some better to the other type. A closer look indicated that this was indeed the case. About half the people had a better response to the processed, white flour bread, and the other half had a better response to the whole wheat sourdough. The lack of differences were only seen when all findings were averaged together.
"The findings for this study are not only fascinating but potentially very important, because they point toward a new paradigm: different people react differently, even to the same foods," says Eran Elinav (@EranElinav), a researcher in the Department of Immunology at the Weizmann Institute and another of the study's senior authors. "To date, the nutritional values assigned to food have been based on minimal science, and one-size-fits-all diets have failed miserably."
He adds: "These findings could lead to a more rational approach for telling people which foods are a better fit for them, based on their microbiomes."
Avraham Levy, a professor in the Department of Plant and Environmental Sciences and another coauthor, adds a caveat to the study: "These experiments looked at everyone eating the same amounts of carbohydrates from both bread types, which means that they ate more whole wheat bread because it contains less available carbohydrates. Moreover, we know that because of its high fiber content, people generally eat less whole wheat bread. We didn't take into consideration how much you would eat based on how full you felt. So the story must go on."

More information: Cell Metabolism, Korem et al: "Bread affects clinical parameters and induces gut microbiome-associated personal glycemic responses." http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30288-7 , DOI: 10.1016/j.cmet.2017.05.002


Provided by Cell Press

New recommendations focus on how nutritional needs change as we age

Older adults “need to be a little more careful about choosing food,” says Alice H. Lichtenstein. “The amount of nutrients per calorie should be relatively high.” Credit: Depositphotos

21 may 2016--Eating right as an older adult takes a bit more effort. Even if you stay the same weight as you age, you have less lean muscle mass and your metabolism slows down, which means you need fewer calories than you once did. At the same time, your nutrient needs stay the same or even increase. Your body may have trouble absorbing certain nutrients, such as B12 and magnesium.
That's why making every bite count is even more important for seniors.
"One needs to be a little more careful about choosing food. The amount of nutrients per calorie should be relatively high," says Alice H. Lichtenstein, director of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts.
To help, Lichtenstein and other HNRCA scientists, with the support of the AARP Foundation, recently released an updated MyPlate for Older Adults, a graphic that provides an at-a-glance overview of what constitutes a healthy diet. On May 18, representatives from the HNRCA and the AARP Foundation will meet with policymakers and advocates for older adults in Washington, D.C., to present the graphic and discuss the nutritional needs of seniors, who often don't get enough of important nutrients. Rep. Jim McGovern, D-Mass., chair of the House Hunger Caucus, will be the featured speaker.
While this is the fourth iteration of the graphic since 1999, its creators say it has never been more important to get such tools into the hands of those who can benefit the most.
A recent survey by the AARP Foundation found that while interest in eating nutritious foods increases with age, understanding of nutrition labels declines. "There is a real need to fill that gap and ensureolder adults have the knowledge and resources they need when they are choosing what to eat," says Alex Lewin-Zwerdling, a senior advisor for the AARP Foundation's Hunger Impact Program.
MyPlate for Older Adults is based on the 2015-2020 Dietary Guidelines for Americans, and its overarching advice could apply to adults of any age. But the graphic and accompanying website provide tips and reminders that are particularly suited to the needs and concerns of seniors.
Lichtenstein, who served as vice chair of the 2015 Dietary Guidelines Advisory Committee, says one of the goals is letting seniors know that they have options. As with the familiar MyPlate put out by the federal government, the MyPlate for Older Adults recommends that half of what seniors eat should be fruits and vegetables.
But getting to the store regularly for fresh produce may be difficult for those who no longer drive, or who "may be reluctant in the winter to go out, especially if they think it is going to be icy," Lichtenstein says. That's why the modified graphic gives equal prominence to frozen fruits and vegetables, as well as to low-sodium canned versions, which have longer shelf lives.

The graphic also acknowledges that seniors may no longer be cooking for a big family, or even a spouse. "With a bag of pre-peeled carrots or frozen broccoli, you can snip it open and just take out a single serving," she says.

Protein and Heart-Healthy Fats

While the general MyPlate gives dairy its own space, the modified MyPlate points out that cheese and yogurt have something in common with fish, eggs, poultry and nut butter. "We moved them into the protein quadrant because dairy is an excellent source of high-quality protein," Lichtenstein says. Some studies have indicated that our need for protein may even increase as we age.
Also with age, people's sense of thirst may decline, and certain medicines increase the risk for dehydration. So the new MyPlate for Older Adults makes a special note of the various ways to get enough fluid in your diet: water, tea, coffee, soups and even many fruits and vegetables.
The graphic also depicts vegetable oils and soft margarines, which provide heart-healthy fats, and reminds seniors to stay active with exercises such as walking, biking and swimming. Recognizing that our sense of taste may change as we age, but that sodium intake may be a concern, the MyPlate for Older Adults encourages the use of herbs and spices, rather than salt, for flavor.
Seniors need more calcium and vitamin D to maintain bone and muscle health, and increasing potassium may lower the risk of developing high blood pressure. Simin Nikbin Meydani, director of the HNRCA and its Nutritional Immunology Laboratory, says that optimal nutrition is particularly important for fighting off illness when we get older. With age, some parts of the immune system start to overperform—resulting in inflammation—and some parts start to underperform—making us more susceptible to infections.
"You have to think of the immune system as a factory," she says. "The factory needs to be ready as soon as it is attacked to produce all kinds of defensive mechanisms. And in order to produce those defensive weapons, it needs to have protein, essential amino acids, essential fatty acids, all kinds of micronutrients. And if you don't have that, it can't make what it needs to get rid of those pathogens."
Infections can also take away appetite and decrease the body's ability to metabolize nutrients, further decreasing the immune system's arsenal. "It becomes a vicious cycle," Meydani says.
Even small changes, such as switching from iceberg lettuce to nutrient-rich spinach in a salad, could make a difference in overall health. (Add in some carrots, apples and berries while you're at it.) All it may take is a pictorial reminder.
"It's very important to have easy ways of helping seniors achieve a healthy diet through user-friendly tools such as MyPlate for Older Adults," Meydani says.


Provided by Tufts University

New dietary guidelines for Americans issued for 2015-2020

09 april 2016—New U.S. dietary guidelines have been released for 2015 to 2020, according to a health policy brief published online March 31 in Health Affairs.
T.R. Goldman, a freelance journalist based in Washington, D.C., reviewed the most recent guidelines, which are officially known by their five-year range rather than a single year. The recommendations were formulated after extensive review of 300 studies, which were used to address 83 questions. In addition, 29,000 public comments were reviewed.
Goldman notes that although most of the new guidelines are consistent with previous advice, there are some differences. The guidelines' overall emphasis is on eating patterns, rather than individual food groups and nutrients. There is a newly introduced recommended limit for added sugars (10 percent of daily calories). Drinking three to five cups of coffee per day is considered part of a healthy eating pattern. The dietary cholesterol limit has been lifted and the recommendation that specific populations reduce their sodium intake from 2,300 to 1,500 mg/day has been removed. In addition, men and teenage boys are encouraged to reduce protein consumption.
"The guidelines undeniably shape the general perception of what healthy eating means, and that perception is ultimately reflected in the food sold everywhere," Goldman writes.

More information: Full Text

Tips for a healthier you in 2015

07 jan 2015--One of the most common New Year's resolutions is to eat healthier. Here, Christine Clark, dietitian for Northeastern University Dining Services and University Health and Counseling Services, offers five strategies for improving your eating habits and overall health in 2015.

Decrease calorie intake: Even something as little as using low-fat milk instead of creamer in your coffee can make a difference over time. Replacing one 12-ounce can of regular soda with a glass of water each day would decrease your weekly calorie intake by up to 1,085 each week. This small change can make a substantial difference.

Exercise often: Find a workout you enjoy. If you start running but don't like to run, you will likely not stick with it. There are great exercise classes available on campus at the Marino Center. Ask a friend to join you because the buddy system can help keep both of you motivated and on track to reach your goals.

Make healthier choices: Reasonable, simple changes can help you start eating healthier. You could begin by including a piece of fruit with your breakfast each day. Once you have accomplished this goal, set out to add a vegetable with dinner a few nights a week until you start eating veggies every night.

Develop a weight-loss plan: Determine how you plan to lose the weight. Watching portion control, cutting back on total calorie intake, or exercising more to burn off extra calories are all small steps that can help you reach your long-term goal. Using smaller plates and bowls is a great way to help you cut down your portion sizes.

Get support from family and friends: Share your goals with family and friends so they can offer encouragement and help you stay focused. A friend can also be an exercise buddy or someone to cook a healthy meal with. You may also consider meeting with the dietitian at UHCS to get even more support.

Trying to revamp your overall diet or begin an intense exercise program can be overwhelming. Creating a program with smaller and more attainable goals will give you a sense of accomplishment every few weeks, which will keep you motivated to reach your ultimate goal.

Provided by Northeastern University

Many middle-aged and older Americans not getting adequate nutrition

New study published in the Journal of the American Dietetic Association evaluates supplement intake

St. Louis, MO, 02 mar 2009 – Micronutrients such as calcium, magnesium, potassium and vitamin C play essential roles in maintaining health. As older adults tend to reduce their food intake as they age, there is concern that deficits in these micronutrients lead to medical problems. In a study published in the March 2009 issue of the Journal of the American Dietetic Association, researchers examined how well different ethnic groups met the recommended daily allowances (RDAs) through food intake and supplement consumption. The study determined that many middle-aged and older Americans are not getting adequate nutrition.

Using data drawn from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study designed to investigate the prevalence, correlates and progression of subclinical cardiovascular disease, researchers examined over 6200 participants from 4 ethnic groups, Caucasian, African American, Hispanic and Chinese. Dietary intakes were determined from food frequency questionnaires and respondents were asked to provide amounts and frequencies of micronutrient consumption using label information from their supplements. These data were used to calculate whether the RDAs or Adequate Intake (AI) levels were being met. The large sample size and multiple ethnic groups in this population gave investigators enough power to examine interactions between supplementation and ethnicity.

Over half of the population took supplements, and supplement users were more likely to be older, women, Caucasian and college-educated. Calcium and vitamin C supplements were most common. Although dietary intake of calcium, magnesium, potassium and vitamin C was similar between supplement users and non-users for both men and women, there were differences in median dietary intake levels between the different ethnic groups. Chinese Americans tended to have the lowest dietary intakes, particularly in calcium where both Chinese and African Americans had significantly lower dietary intakes of calcium than Caucasians and Hispanics.

The study also evaluated differences between multivitamins and high-dose supplements. While high-dose calcium was associated with meeting RDA/AIs for all ethnic groups, some high-dose supplements could also cause users to exceed their Tolerable Upper Intake Levels (ULs). For calcium, 15.0% of high-dose users exceeded the UL compared to 1.9% of multivitamin users and 2.1% of non-users. For magnesium, 35.3% of high-dose supplement users exceeded the UL compared to 0% of both multivitamin users and non-users. In addition, 6.6% high-dose vitamin C users exceeded the UL compared to 0% of both multivitamin users and non-users.

The study also found that potassium intake was very much below the RDA whether supplements were taken or not. This could point to a need to reformulate supplements to deliver higher potassium doses.

Writing in the article, Pamela J. Schreiner, MS, PhD, Professor and Director of Graduate Studies, Division of Epidemiology and Community Health, University of Minnesota, states, "The present study indicates a clear association between meeting RDA/AIs and supplement use for calcium, magnesium and vitamin C. However, even with the assistance of dietary supplements many middle-aged and older Americans are not getting adequate nutrition, and there was no association between supplement use and meeting the AI for potassium. In addition, those taking high-dose vitamin supplements were more likely to exceed the UL for that nutrient. Future studies should explore dietary supplementation along with other methods to improve nutrition in middle-aged and older Americans."

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The article is "Supplement use contributes to meeting recommended dietary intakes for calcium, magnesium and vitamin C in four ethnicities of middle-aged and older Americans

APSS: Poor Sleep and Insomnia May Lead to Impaired Nutrition

MINNEAPOLIS, June 13 -- Poor sleepers may be too tired during the day to eat properly, according to researchers here.
Yet by increasing the amount of sleep time -- or at least the amount of time in bed before getting up -- there may be a reduction in caloric intake, researchers reported at the Associated Professional Sleep Societies meeting.
"Persons with sleep complaints such as insomnia are less likely to eat at home," said psychologist Mindy Engle-Friedman, Ph.D., of Baruch College of the City University of New York. "These meals outside the home may require less effort and may be less healthful than meals prepared at home."
"Over time, persons with sleep complaints may have weight or health problems related to their nutrition," she said.
She studied the sleep and diet of 21 healthy undergraduates -- 12 men and nine women -- for seven days. She said the differences between the those eating at home and those who ate more in restaurants reached statistical significance (P<.05) on days two, four, and seven, and trended towards significance on the other days in the study.
"There are commuting students so they are either preparing meals at home or are eating meals that are prepared by their parents," Dr. Engle-Friedman said. "We have found that meals prepared at home are healthier than those in restaurants -- the home-cooked meals have less, fat and have less salt, generally. We have recorded the foods that the students ate during this study and we are analyzing that data now."
She said insomniacs or those who have problems awakening or have reduced sleep times tend to put less effort into their activities of daily living. "They take the easier way out, and when that comes to eating, it is easier to stop into a fast food restaurant than to prepare a meal oneself or wait for it to be ready. By not putting enough effort into preparing their food they are having a negative impact on their nutrition."
Dr. Engle-Friedman noted previous epidemiological studies that suggested dining out at restaurants -- especially fast food restaurants -- has been associated with a 10-pound weight gain over 15 years, and that sleep loss is also associated with insulin resistance, a precursor to diabetes.
In an experiment at Hendrix College in Conway, Ark., researchers persuaded 32 summer school student volunteers to keep diaries of the food s that they ate for three weeks and how much time they slept each day, including naps. After one week of baseline sleep and meal were assessed, the participants were told to try to stay in bed two hours longer a night for each night of week two. In week three they were allowed to return to their normal routine.
"What we found was that the students in week two would go to bed earlier and that then would eat nearly 300 calories a day less," said psychologist Jennifer Peszka, Ph.D., of Hendrix.
"We wondered whether the lower intake was due to the students just not recording their entire food intake -- getting tired of the task after two weeks," she said at her poster presentation. "But the food intake went up almost to baseline during the third week."
Dr. Peszka said that the sleep diaries showed that the students were getting about seven hours of sleep a day -- a sleep deprivation of about two hours for persons their age. At baseline, the students who said they felt sleepy during the daytime averaged about 2,100 calories of food a day compared with about 1,800 calories a day for the students who said they didn't feel sleepy. Both groups showed similar calorie dips in the second week when they were in bed longer.
"It's possible the calorie dip reflects less hunger among the students, or it could mean they are not having a late night snack or they drank less soda at night to keep them awake," she said. On-going studies will try to decipher that.
Although the studies were different in time and scope, Dr. Peszka said there was nothing in her study that contradicted the results of Dr. Engle-Friedman's study among urban college students. "These studies seem to mesh very well," Dr. Peszka said. "Sleepy people tend to consume more food." Primary source: SleepSource reference: Mindy Engle-Friedman, "Abstract 0673: DO SLEEP PROBLEMS AFFECT WHAT WE EAT?"Sleep 2007, 30, supplement,p A228.
Jennifer Peszka, "Abstract 1102: DOES ONE WEEK OF SLEEP EXTENSION IMPACT EATING BEHAVIOR IN HEALTHY YOUNG ADULTS? "Sleep 2007, 30, supplement,p A379.