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The rise and fall of dietetics and of nutrition science, 4000 BCE-2000 CE.

OBJECTIVE: To outline the history of dietetics since its beginnings in recorded history, and of nutrition science in its first phase beginning in the mid-nineteenth century and then its second phase in the second half of the twentieth century. METHOD: Three narrative overviews: of dietetics from its beginnings until after the end of the medieval and then Renaissance periods in Europe; of nutrition science in its first phase from its beginnings in the mid-nineteenth century until the middle of the twentieth century, with reasons for its rise; and of nutrition science in its second phase in the second half of the twentieth century, with reasons for its decline. CONCLUSIONS: In its third phase in the twenty-first century, the new nutrition science should regain much of the vision and scope of its preceding disciplines.

Dietetics↗

[Are drugs necessary in the treatment of obesity?].

INTRODUCTION: The main principles of obesity treatment are dietetic nutrition, physical activity and psychotherapy. Drug therapy is adjuvant, time limited and can be applied only with the mentioned therapeutic measures. An ideal antiadipose agent induces a potent decrease of body mass on the account of fat depot, it can be administered for a prolonged time without developing resistance, it should not be accompanied by significant side effects, and it has no negative effects on the obesity-related diseases. ANTI-OBESITY AGENTS: Nowadays, there are mainly two groups of drugs in use, having different mechanisms of action: appetite suppressors and fat resorption inhibitors. From the first group of drugs the most suitable is dexfenfluramine, which is applied in obese nervous and tense subjects and in cases of compulsive food intake whereas fat resorption inhibitors (tetrahydrolipstatin, orlistat) are especially recommended to obese patients with accompanying hyperlipoproteinemia. Insulin-dependent form of diabetes is an indication for administration of drugs from this group. CONCLUSION: Of course, before applying drugs it is necessary to thoroughly consider indications and especially contraindications of their action. In respect to the treatment duration, three-month treatments are mainly recommended. Prolonged courses are acceptable only if well-controlled studies are in question.

Anti-Obesity Agents↗

[Change in the sugar content in oaten products, buckwheat and rice groats during their heat processing by cooking].

The sugar content in the grits and in a gruel cooked with samples of oats and buckwheat subjected to hydrothermal treatment under different conditions and also in the oat flour, a product of baby and dietetic nutrition, was quantified. Hydrothermal processing results in significant changes occurring individual sugars of the grit. During culinary treatment these changes are levelled out, but in the end the level of virtually all types of sugar is higher in the gruel cooked with hydrothermally treated grit than in that prepared with initial, untreated grit. The oats flour is distinguished by a high glucose, maltose, fructose and saccharose content. A fall of the reducing sugars level coming as a result of thermal and culinary treatment is explained by their participating in the reaction of melanoidine formation. On the other hand, a rise in their content under rigorous conditions and in the production of oat flour is due to the starting of the starch hydrolysis.

Carbohydrates↗

[Study of glucose resorption during rhythmic protein feeding in a chronic experiment on white rats].

In three experimental groups of white rats receiving cacein in the morning, at noon and at night, over a period of one month, glucose resorption was studied in the hours of casein alimentation. The method of accumulating preparation from the mucosa "in vitro" was employed, and parallel to glucose resorption, maltase activity was also investigated. The results obtained are discussed in the light of modern concepts on membranous digestion and active transport, and more particularly, on interactions of the monomers at membrane level. Interpretation is made of the marked resorption of glucose, observed in the experimental group receiving casein at noon, and the possibility of practical application of the results recovered in rational dietetic nutrition is discussed.

Animals↗

[Effects of the process of pharmaceutical deregulation on physicians].

By the term deregulation economists indicate the modulation of regulatory intervention resulting in a decrease of the limitation and restriction imposed on manufacturing and marketing activities. The process applies even to the pharmaceutical area and is enhanced by the increasing subjectivity of the consumers and the irreversible involvement of the medical profession with public expenditure. Health demand is no longer totally and exclusively fulfilled by physician's intervention and prescribing. Therefore, the resulting demedicalization and the use of means other than medications, such as surgical and medical aids, nutritional, dietetic and sanitary products and the so called medicated cosmetics, impose modifications of the preexisting regulation and organization. Generics will follow the assignment of a medicinal product to one class of medicaments rather than to another, thus allowing the adoption of substituting programs. Both national and European legislations follow this trend to attain economical advantages through pharmaceutical deregulation. The medical profession is changed by this process in a way which is much more significant than any other event.

Europe↗

[Comparative biological value of new canned child and dietary foods with supplements of fat-free curds and sodium caseinate (experimental study on weanling rats)].

The effect of introduction of milk proteins in a novel homogenized canned meat of the "Kroshka" type for child and dietetic nutrition was studied. It was shown in animal experiments that introduction of sodium caseinate and fat-free curds in a 5% amount into canned meat raises the biological value of canned food and exerts a favourable effect on some metabolic parameters of the growing organism.

Animals↗

The King's College Hospital Acute Stroke Unit.

The King's College Hospital (KCH) Acute Stroke Unit (ASU) was set up in January 1994 in order to provide acute management for patients admitted with stroke and to undertake biomedical research. Of 206 patients admitted to KCH with a stroke or suffering an in-hospital stroke, 141 (68%) patients were admitted to the ASU over its first 6 months of operation: 120 (85%) were from the Accident and Emergency Department and 21 (15%) from other wards. Management included resuscitation and medical stabilisation, investigation, prevention of stroke complications (including aspiration, venous thrombosis, and pressure sores), rehabilitation (physiotherapy, occupational therapy, speech and language therapy), nutrition (dietetics) and initiation of secondary prevention measures (aspirin or anticoagulation, blood pressure and lipid lowering, and carotid endarterectomy). All aspects of management are driven by agreed guidelines. Patients remain under the care of the admitting physician but specific stroke management and guidance is provided by two research doctors and the unit's nurses, therapists and dietician. The unit also facilitates research into stroke pathophysiology and acute therapeutic interventions. Our experience suggests that an ASU is relatively easy to set up and may contribute to improved care. Whether ASUs improve patient survival and functional outcome, and are cost-effective, requires further study.

Acute Disease↗

Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 4. Dietetic services and nutritional issues.

AIMS: To examine the provision of, and variations in, dietetic services for diabetes in secondary care in the UK. METHOD: A postal survey of all secondary care providers of diabetes services. RESULTS: There was a 77% response rate. A dedicated dietician supported diabetes services in 73% of responses, but only 45% were able to see newly diagnosed patients within 1 month. Only 3% of responses documented that dietetic services provided the recommended minimum 22 h weekly input to diabetes care, and an annual dietetic review was said to be available in 15%. An opportunity for more frequent visits was most likely if there was poor glycaemic control (78% of responses), particularly when services were provided by a dedicated diabetes dietician. Although dieticians frequently provided input to patient education (88%), specific training for this purpose and provision for continuing education of these individuals was less common (14% and 63%, respectively). Nutritional guidelines were available in 74%, but only 31% of responses documented current guidelines on obesity management. Of bids for additional dietetic resources, only 21% had been successful. There was evidence of regional variation in service provision, and no greater provision of dietetic services in areas with a large South Asian population and an expected high prevalence of diabetes. In broad terms, dietetic services for diabetes care had not altered in comparison with a similar survey in 1997. CONCLUSIONS: The level of dietetic support of secondary care diabetes services remains dramatically lower than recommended in advisory documents, and appears to have changed little over the last 3 years. This is compounded by marked regional differences, and was no better in areas with a higher than average prevalence of diabetes. The survey also highlights the need for more co-ordinated and structured education and training of dieticians as well as more consistency in nutritional guidelines.

Diabetes Mellitus↗

Attitude changes of dietetic students performing nutritional assessment on healthy elderly.

As the population of individuals over 65 yrs of age continues to grow, so does the demand for nutrition counseling and intervention for this age group. Dietetic students traditionally have minimal exposure to groups of healthy elderly yet entry level dietitians must effectively interact with these groups immediately upon employment. Attitudes and perceptions held by dietetic students about the elderly are important to their professional development and may affect the quality of care these students provide in the future. This study investigated attitudes of dietetic students before and after a short, direct experience with a group of elderly. Students had a significant positive change in attitudes as a result of interacting with the older adults.

Adult↗

Prevalence of eating disorders among dietetics students: does nutrition education make a difference?

Several studies have indicated that college students majoring in dietetics have more problems associated with food than do students majoring in other disciplines. If this is true, dietetics students may need more counseling and education on eating disorders, especially because many will eventually be counseling others professionally. To assess the prevalence of negative eating behaviors among college dietetics majors, surveys based on the Eating Pattern Questionnaire were distributed to college women with majors in dietetics and other selected disciplines at a medium-sized California university. Two surveys were administered 1 year apart; the first was distributed to junior and senior women only, and the second was distributed to women of all class levels. Results from the first survey revealed that the incidence of eating disorders was not greater among the dietetics majors than among the other selected majors. In fact, dietetics majors often had more positive responses to questionnaire items, which suggests that dietetics students have better eating habits and fewer eating disorders. The results of the second survey, however, indicated that dietetics majors had significantly more negative eating patterns than did students from other majors. When separated by class, junior and senior dietetics majors had significantly more positive eating habits than did freshmen dietetics majors. These findings imply that junior and senior dietetics majors may have more positive eating patterns than freshmen dietetics majors as a result of their increased exposure to nutrition information.

Adult↗

A study among dietitians and adult members of their households of the practicalities and implications of following proposed dietary guidelines for the UK. British Dietetic Association Community Nutrition Group Nutrition Guidelines Project.

Four hundred and seventy-two dietitians and adult members of their households took part in a research project carried out by the British Dietetic Association's Community Nutrition Group. They first kept 7-day weighed food diaries of their normal eating habits. These were analysed and compared with the dietary goals set by the study. The participants who did not 'achieve' the goals were then asked to keep a second 7-day weighted diary while trying to eat a diet conforming to the dietary goals which were based on the NACNE long-term guidelines; 351 people did so. Mean nutrient intakes on first diaries were within the short-term goals recommended by the NACNE report except for fat and when participants were consciously altering their diets they achieved all the long-term goals. Average intakes were: fat, 30 per cent of energy; saturated fat; 10 per cent of energy; added sugar, 7 per cent of energy; alcohol, 4 per cent of energy; dietary fibre, 38 g; and sodium 2690 mg. The goals for total fat and saturated fat were the hardest to achieve. There was a significant drop in energy intake between the first and second diaries from 7.99 (s.d. +/- 1.54) MJ to 7.05 (s.d. +/- 1.25) for women (P less than 0.001) and 10.92 (+/- s.d. 1.76) MJ to 9.42 (s.d. +/- 1.54) MJ for men (P less than 0.001). The percentage of energy from fat and added sugars and the amount of sodium and fibre in the diet tended to increase with energy intake. None of the men in the highest energy band (12.56 MJ) achieved the goal for sodium. The diet which achieved the goals was more nutrient-dense than the diet which did not with significant increases in 14 vitamins and minerals despite the drop in energy. Participants experienced some problems in achieving the goals but not as many as had been anticipated.

Adult↗

Practice guidelines for nutrition care by dietetics practitioners for outpatients with non-insulin-dependent diabetes mellitus: consensus statement.

In summary, nutrition practice guidelines for dietitians who provide outpatient care for persons with NIDDM provide a roadmap for nutrition care that allows for consistency in individualized care. A field test that compares care according to practice guidelines with usual or basic care can provide evidence, based on medical, education/behavior, and cost outcomes, that practice guidelines are not only reasonable and realistic but also effective.

Ambulatory Care↗

Dietary acculturation: applications to nutrition research and dietetics.

The US immigrant population is growing dramatically, making the health status of racial/ethnic minorities an increasingly important public health issue. Immigration to the United States is usually accompanied by environmental and lifestyle changes that can markedly increase chronic disease risk. In particular, adoption of US dietary patterns that tend to be high in fat and low in fruits and vegetables is of concern. The process by which immigrants adopt the dietary practices of the host country--called "dietary acculturation"--is multidimensional, dynamic, and complex; in addition, it varies considerably, depending on a variety of personal, cultural, and environmental attributes. Therefore, to intervene successfully on the negative aspects of dietary acculturation, it is important to understand the process and identify factors that predispose and enable it to occur. In this report, we give an overview of acculturation, define dietary acculturation and present a model for how it occurs, discuss measurement issues related to dietary acculturation, review the literature relating acculturation to eating patterns, and provide a case study illustrating how information on acculturation can be used to design dietary interventions in 2 markedly different immigrant groups. Finally, we give applications for nutrition researchers and dietetic practitioners. Studies investigating associations of acculturation with disease risk should identify and intervene on those steps in the acculturation process that are most strongly associated with unhealthful dietary changes. Practitioners working with immigrants should determine the degree to which dietary counseling should be focused on maintaining traditional eating habits, adopting the healthful aspects of eating in Western countries, or both.

Acculturation↗