Discrepancies Between Australian Eating Disorder Clinicians and Consumers Regarding Essential Components of Dietetic Treatment

BackgroundA recent Delphi study indicated that, compared with eating disorder (ED) consumers and carers, ED specialists were less likely to endorse involvement of a dietitian as a standard component of treatment. In addition, there was disagreement between these groups regarding the inclusion of a number of components of dietetic treatment.ObjectiveThis study aimed to further investigate these data to identify areas of disagreement among ED specialist dietitians, ED specialist non–dietetic clinicians, consumers, and carers with regard to outpatient dietetic treatment.Design and participants/settingThe ED specialists panel from a previous Delphi study was recoded into 2 panels: ED specialist dietitians (n = 31) and ED specialist non–dietetic clinicians (n = 48) to compare responses of these panels with responses from consumers (n = 32) and carers (n = 23).Main outcome measuresStatements in 7 categories relating to referral to dietitian, essential components of outpatient dietetic treatment regarding 4 ED patient populations, strategies to promote multidisciplinary collaboration, and skills dietitians should possess if treating patients with an ED were rated on a 5-point Likert scale.Statistical analysis performedOne-way analysis of variance was conducted with post-hoc multiple comparisons to compare mean statement ratings.ResultsThirty-seven statements (30%) showed statistically significant differences (P < .05) in responses between panels. Discrepancies were primarily observed for statements regarding how and when dietetics is included in treatment and essential components of dietetic treatment, particularly the use of behavioral tasks, such meal plans and self-monitoring. Results also highlighted deficits in participants’ understanding of core responsibilities of dietitians in ED treatment and dietitians “drifting” from delivering evidence-based components of dietetic treatment.ConclusionsResults of this study show discrepancies among ED dietitians, clinicians, consumers, and carers regarding what dietetic treatment for people with EDs should encompass. It also indicates the need for further research into optimizing dietetic treatment for EDs that is conducted in collaboration with individuals with lived experience.     

Frequency of Sweet and Salty Snack Food Consumption Is Associated with Higher Intakes of Overconsumed Nutrients and Weight-For-Length z Scores During Infancy and Toddlerhood

BackgroundCurrent dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.ObjectiveThe aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.DesignA cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.Participants and settingA sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.Main outcome measuresThree 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.Statistical analysisDaily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.ResultsInfants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.ConclusionsSnack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.     

Arterial Stiffness in Renal Transplant Recipients: 5-Year Follow-up

BackgroundChronic kidney disease is a risk factor for cardiovascular diseases. After renal transplant, some traditional and chronic kidney disease–specific risk factors vanish, but new risk factors emerge. This retrospective study aimed to define the long-term impact of renal transplant and diabetes mellitus on arterial stiffness, evaluated by measuring pulse wave velocity (PWV) and augmentation index (AI) and on myocardial perfusion, evaluated by subendocardial viability ratio (SEVR).MethodsPWV, AI, and SEVR were evaluated noninvasively by applanation tonometry using SphygmoCor in the first 4 weeks after kidney transplant and 4 to 5 years thereafter.ResultsA total of 48 graft recipients (18 women, 30 men; mean ± standard deviation age, 47.9 ± 11.8 years) were included. The follow-up period was 57.4 ± 8.0 months. PWV did not change significantly during the follow-up period (9.1 ± 1.8m/s and 8.7 ± 1.8m/s, respectively; P = .137). In the subgroup of patients without diabetes mellitus, we observed a trend of PWV reduction, whereas in the subgroup of patients with diabetes we observed the trend of PWV increase. The duration of smoking before transplant correlated significantly with PWV (P = .012). AI in the whole group increased significantly during the study period (from 18.3% ±10.3% to 25.9% ±9.4%; P < .01) as well as SEVR (from 134.9 ± 23.1 to 155.4 ± 28.6; P = .001).ConclusionsPWV, reflecting the central vessel stiffness, did not change significantly in the whole group during the follow-up period. The AI, which indicates systemic stiffness, increased significantly within 5 years after transplant, indicating the progression of vascular processes of elastic and muscular arteries. Significant increases in the SEVR values in both diabetics and nondiabetics indicate the long-term favorable effect of kidney transplant on myocardial perfusion.     

Ischemic toe after surgery for lesser toe deformities: An algorithm

Ischemia after correction of lesser toe deformities is usually due to temporary vasospasm and can rarely cause gangrene. The published literature on dealing with the issue and been reviewed and used to suggest an algorithm for a logical step by step approach to a pale or white toe when encountered in the postoperative period.