Translation of the diabetes nutrition recommendations for health care institutions: technical review

Translating current dietary guidelines into a culturally tailored nutrition education program for Korean American immigrants with type 2 diabetes

PURPOSE

The purpose of this article is to describe the process of translating evidence-based dietary guidelines into a tailored nutrition education program for Korean American immigrants (KAI) with type 2 diabetes mellitus (DM).

METHODS

Community-based participatory research (CBPR) is a research process involving researchers and communities to build a collaborative partnership. The study was conducted at a community-based organization. In a total of 79 KAI (intervention, n = 40; control, n = 39) with uncontrolled type 2 DM (A1C ≥ 7.5%), 44.3% were female and the mean age was 56. 5 ± 7.9 years. A culturally tailored nutrition education was developed by identifying community needs and evaluating research evidence. The efficacy and acceptability of the program was assessed.

RESULTS

In translating dietary guidelines into a culturally relevant nutrition education, culturally tailored dietary recommendations and education instruments were used. While dietary guidelines from the American Diabetes Association (ADA) were used to frame nutrition recommendations, additional content was adopted from the Korean Diabetes Association (KDA) guidelines. Culturally relevant intervention materials, such as Korean food models and an individually tailored serving table, were utilized to solidify nutritional concepts as well as to facilitate meal planning. Evaluation of the education revealed significantly increased DM-specific nutrition knowledge in the intervention group. The participants' satisfaction with the education was 9.7 on a 0 to 10-point scale.

CONCLUSION

The systematic translation approach was useful for producing a culturally tailored nutrition education program for KAI. The program was effective in improving the participants' DM-specific nutrition knowledge and yielded a high level of satisfaction. Future research is warranted to determine the effect of a culturally tailored nutrition education on other clinical outcomes.

Patients report positive nutrition counseling outcomes

OBJECTIVE

Assess outcomes of patient nutrition counseling.

DESIGN

A descriptive study based on the results of a telephone interview performed 2 to 8 weeks after counseling.

SUBJECTS/SETTING

Subjects were 400 adult patients referred for nutrition counseling at 2 academic health centers. Of these, 274 patients received nutrition counseling during hospitalization and 126 as outpatients.

STATISTICAL ANALYSIS

Descriptive statistics were used to summarize data and the Mann-Whitney U statistic and logistic regressions were used to test significant differences (P < .05) between inpatient and outpatient counseling outcomes.

RESULTS

Most patients (83%) gave a partial or full description of their diet modifications and 79% had a moderate or good understanding of their diet. Most patients reported that the dietitian's advice was suited to their special needs (88%) and that they knew what to eat (83%). A majority (62%) had made dietary changes, but 17% said they had had trouble changing their diets as suggested. After talking with a dietitian, 57% felt better emotionally, 37% felt better physically, 64% felt in control of their condition, and 43% noticed improved health indicators. Initial analysis indicated that outpatients reported better outcomes than inpatients; further analysis showed that these differences could be attributed to younger ages among the outpatient sample.

APPLICATIONS/CONCLUSIONS

Patient nutrition counseling has positive outcomes. Therefore, key counseling points should be introduced or reinforced in inpatient settings, in conjunction with multiple-session protocols during the pre- and/or posthospitalization continuum of care. Dietitians, managers, administrators, and credentialing agencies should work together to secure and promote the necessary physical, personnel, and financial resources to make this happen.

Position of the American Dietetic Association: liberalized diets for older adults in long-term care

Malnutrition, weight loss, and resident satisfaction are serious issues that need to be addressed by dietetics professionals working in long-term-care facilities. Medical nutrition therapy for older adults in long-term care is multifaceted and critical to reducing the risks of malnutrition and weight loss. To meet the needs of every resident, dietetics professionals must consider each person holistically, including personal goals, overall prognoses, benefits and risks of treatment, and perhaps most important, quality of life. For some long-term-care residents the use of liberalized diets, when appropriate, can enhance both quality of life and nutritional status, thus increasing the resident's satisfaction with the meals provided and reducing the risks of malnutrition and weight loss.