Background
Research is the scientific basis for the profession of dietetics, as it must be located and applied in evidence‐based practice (EBP). EBP is often presented as a foundational skill for ...research. CEAR – Core, Evidence Application, Research – is a newly proposed model that separates Research and Evidence Application skills into distinct domains, jointly supported by a set of Core skills, thus acknowledging that education and advancement in one domain neither requires nor precipitates education and advancement in the other. The goal was to investigate the content and construct validity of the new CEAR Model.
Methods
A cross‐sectional online survey of randomly selected dietitians in the United States was used to collect CEAR domain scores, validated measures of research or EBP skills and self‐reported characteristics. Exploratory factor analysis, Cronbach's α and Pearson correlation between various tools and CEAR domains were used to assess validity and reliability. Analysis of variance (ANOVA) and multiple linear regression between CEAR domains and participant characteristics were used to assess convergent and divergent validity.
Results
One hundred and fifty‐four responses with a valid CEAR score were received and led to a three‐factor solution, supporting the theorised differentiation of research from evidence application skills (content validity). Internal reliability for the CEAR Model overall and for each domain was high. The hypothesised correlations between existing research or EBP measurement tools and the relevant CEAR domains were found (construct validity). Known groups analysis demonstrated the expected differences in CEAR domain scores based on participant characteristics.
Conclusions
The CEAR Model demonstrates preliminary validity and internal reliability. It adds to the current literature by acknowledging the separateness of evidence application skills from research skills.
The differentiation of research and evidence application skills as illustrated in the Core, Evidence Application, Research Model has good internal reliability, preliminary content and construct validity based on factor analysis, correlation with existing tools and known groups analysis.
This model will help guide future education and professional development in nutrition and dietetics.
Key points
The differentiation of research and evidence application skills as illustrated in the Core, Evidence Application, Research (CEAR) Model has good internal reliability, preliminary content and construct validity based on factor analysis, correlation with existing tools and known groups analysis.
This model will help guide future education and professional development in nutrition and dietetics.
There is currently no standard, objective definition of selective eating. This is partially because normative values for the number of different foods eaten by US children have not been established. ...The present study objectives were to: (i) perform exploratory analysis on the number of different foods, beverages, and total foods and beverages consumed by US children aged 2-18 years over a year's time, and the types of foods consumed by those in the lowest 2·5th percentile; and (ii) determine whether those values differ according to demographic variables and weight status.
Secondary analysis of cross-sectional FFQ data. Differences in number of foods, beverages, and total foods and beverages were analysed using one-way ANOVA.
National Health and Nutrition Examination Survey (NHANES) for the years 2003-2006.
Non-institutionalized US children aged 2-18 years.
The mean number of different foods and beverages consumed across the sample was 83·2. There were no significant differences by gender, BMI, race or food security categories. There was a difference in beverage consumption by age category, with children aged 12-18 years consuming a significantly higher number of different beverages compared with each of the other two age categories (i.e. 2-5 years and 6-11 years).
Normative values for the number of foods and drinks reported as consumed by children over the past 12 months may be a useful measure for researchers. Future research validating this measure is needed before cut-off values can be used to develop a definition of selective eating.
Abstract Background This study aimed to (1) evaluate the current status of obesity education at Case Western Reserve University School of Medicine (CWRU) (2), introduce a comprehensive first-year ...curriculum on obesity, and (3) assess the impact of the curriculum on self-reported attitudes and knowledge regarding obesity among first-year medical students. Methods The preclinical curriculum at CWRU was reviewed to determine the degree of coverage of Obesity Medicine Education Collaborative (OMEC) competencies for healthcare professionals, and recommendations were provided for revising the curriculum to better adhere to these evidence-based competencies. A survey on obesity attitudes and knowledge was given before and after the implementation of the new curriculum to measure intervention-related changes. Changes in obesity attitudes and knowledge were compared (1) before and after the intervention for the class of 2025 and (2) after the intervention for the class of 2025 to a historical cohort that did not receive the intervention. Results Among the 27 competencies examined in the audit, 55% were unmet and 41% were partially met. Of 186 first-year medical students (M1s), 29 (16%) completed the baseline survey and 26 (14%) completed the post-intervention survey. Following the intervention, there was a notable improvement in attitudes and knowledge regarding obesity. Specifically, there was a significant decrease in the belief that obesity is caused by poor personal choices, and knowledge of obesity in fourteen out of fifteen areas showed significant improvement from pre- to post-intervention. Additionally, obesity attitudes and knowledge were significantly better post-intervention when compared to the historical cohort. Conclusions The improvements made to the preclinical curriculum through this project improved obesity attitudes and knowledge among first-year medical students. This method provides a practical approach for evaluating and enhancing obesity education in medical school curricula.
Nutritional quality of children's diets is a public health priority in the fight against childhood obesity and chronic diseases. The main purpose of this study was to determine contribution of snacks ...to energy and nutrient intakes and to identify leading snack food sources of energy, total fat, and added sugars amongst young children in the United States. Using the 2005–2012 NHANES data, dietary intakes of 2‐ to 5‐year‐old children were analysed from a parent‐reported 24‐hour dietary recall (n = 3,429). Snacking occasions were aggregated to determine the proportion of total food/beverage intake obtained from snacks, estimate energy, and nutrient intakes, and identify the leading snack food sources of energy, added sugars, and total fat. Nearly all children consumed a snack on the reported day (62% morning, 84% afternoon, and 72% evening). Snacks accounted for 28% of total energy intake, 32% of carbohydrates, 39% of added sugars, and 26% of total fat and dietary fiber intakes for the day. Snacking occasions accounted for 46.6% of all beverages consumed on the reported day. Snacks and sweets food category (i.e., cookies and pastries) were the leading sources of energy (44%), total fat (52%), and added sugars (53%) consumed during snacking occasions. Sweetened beverages (e.g., fruit and sport drinks) contributed 1‐quarter of all added sugars obtained from snacks. Snacks contribute considerable amount of energy and nutrients to young children's diets, with a heavy reliance on energy‐dense foods and beverages. Targeted interventions are needed to improve the nutritional quality of snacks consumed by young children.
This paper presents a simulation process to augment nutrition surveillance in the United States which incorporates product innovation data. Traditional point‐estimates of nutritional quality in a ...food category are compared to those based on distributions of nutrient compositions using product‐level variability seen in the market. Nationally representative consumption patterns provide dietary intakes. Cookies are used as an example food category. Nutrient composition data from Global New Product Database (GNPD) for 5259 cookies launched 2005 to 2012 were matched to dietary intakes from 2005 to 2012 National Health and Nutrition Examination Survey (NHANES) over the 2 y cycles of NHANES for 8284 cookie consumers. Average dietary intakes from traditional NHANES and GNPD‐based estimations produced similar mean values for energy, carbohydrates, sugars, total fat, and protein. Saturated fat, fiber and cholesterol contributions using new product compositions were significantly higher than traditional NHANES approaches, estimates of sodium were significantly lower. These differences become pronounced when comparing adult and child consumption patterns and over time. This process also simulated trans fat consumption estimates not traditionally available within NHANES. On average cookies contributed 0.3 g/d (range 0 to 4.1 g/d). Much variability in food composition is seen in the market which is shown to influence estimates of the national diet.
Practical Application
Numerous factors drive changes in the food supply, including health trends, firm strategic choices, and food policy. This evolution presents a challenge for dietary assessments and nutrition monitoring. The public health impact of variability in nutritional composition, subpopulation consumption patterns and market dynamics are particularly difficult to evaluate and are shown to influence estimates of the national diet.
Background: Registered dietitians (RDs) are an important part of the interdisciplinary team required for effective obesity care. However, the extent of obesity training for RDNs has not been studied. ...The objective of this study was to benchmark the inclusion and perceived importance of obesity-related competencies in US dietetic supervised practice (SP) programs, which are a required part of clinical training for all RDs. Methods: This cross-sectional survey study was modeled after previous studies of obesity-related medical training. The survey was based on the 2017 interprofessional Provider Competencies on the Prevention and Management of Obesity and was emailed to all 319 SP directors in the US. Participants were asked to rate the extent to which each of the 31 competencies are incorporated into their program using a 4-pt Likert scale. The survey also included questions about barriers. Results: We received 34 responses, representing 10% of SP directors. 55% (n=21) indicated that teaching students about the prevention or treatment of obesity is an intentional program objective. The most commonly included competencies were 'evaluate BMI' and 'perform effectively in an interprofessional team', reported as being covered to a "great extent" by 82% and 71% of respondents, respectively. Very few programs reported "not at all incorporated" for any competencies; the most frequent were 'potential role of genetics/epigenetics' (15%, n=5) and 'physiology/pathophysiology of obesity' (12%, n=4). 'Perform effectively in an interprofessional team' and 'discuss obesity in a non-judgmental manner' were considered "very important" by 94% and 88% of respondents, respectively. The most frequently reported barriers were lack of room in the curriculum and lack of obesity-related rotation sites, reported as a moderate or large barrier by 68% and 53% of respondents, respectively. Conclusions: This study is the first step to understanding the degree to which RDs are trained in obesity, and the perceived importance of obesity training. Some competencies are integrated to a high degree, while others are incorporated very little due to various barriers.
IntroductionObesity is a multifactorial chronic disease and a major contributor to numerous health conditions. Despite the high prevalence, costs, and health effects of obesity, physicians are ...largely unprepared to treat it. Most medical students and residents lack sufficient training in obesity and obesity management.MethodsWe evaluated a two-part team-based learning seminar (TBL) on obesity pathogenesis and treatment for first-year medical students at Case Western Reserve University School of Medicine (CWRU SOM). A questionnaire on attitudes toward obesity and self-perceived knowledge of obesity was administered before and after the TBL, utilizing Likert scales.ResultsOf 183 medical students who attended both TBLs, 155 (85%) completed the baseline questionnaire, and 127 (69%) completed the postintervention questionnaire. Confidence in treating obesity increased significantly from preintervention (M = 2.7, SD = 1.0) to postintervention (M = 3.7, SD = 0.8). The attitude that obesity is caused by poor personal choices decreased significantly from preintervention (M = 2.8, SD = 0.9) to postintervention (M = 2.1, SD = 0.9). Self-perceived knowledge of obesity in all nine areas-epidemiology, energy homeostasis, etiologies, nutrition, physical activity, behavior, pharmacology, surgery, and language-increased significantly.DiscussionDespite obesity being one of the most prevalent health concerns, obesity education in medical school is scant. This TBL resulted in improved attitudes toward obesity and self-perceived knowledge of obesity among first-year medical students at CWRU SOM and offers a practical mechanism to introduce more obesity education into undergraduate medical curricula.
To compare the consumption patterns and diet quality of foods and beverages obtained from various sources by food security status.
Cross-sectional analysis of 2011–2012 National Health and Nutrition ...Examination Survey data.
A total of 4,789 adults (aged >19 years) with dietary intake and food security data.
The contribution of foods and beverages to energy, nutrients, and diet quality by locations where food was obtained was compared across food security status.
Descriptive analysis and logistic regression.
Almost all US adults consumed food and beverages obtained from grocery stores, regardless of food security status (about 95%), which accounted for one half to two thirds of total macronutrient intakes. The diet quality of foods from grocery stores was better in highly food-secure adults. Convenience stores are used most by very low food-secure adults; those foods had the poorest diet quality profile. Dietary patterns of marginally food-secure adults more closely resembled sources and intakes of low and very low food-secure adults.
Food-insecure adults use food sources differently, resulting in diet quality differences of foods and beverages obtained. Place-based interventions in the food environment may have differential effects by food security status.
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