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Objective: To examine the distribution of behavioral strategy use across stage of change for healthful eating, and to determine if baseline stage predicts change in use of strategies over 1 year in the absence of intervention., Design: Cross-sectional assessment and 1-year follow-up with no intervention., Subjects/setting: Adult men and women in two rural Midwest communities., Statistical Analyses Performed: Multiple regression, with tests for group difference and trend, controlling for age and sex., Results: Use of behavioral strategies as measured by six scales (self-monitoring, planning, preparation and buying, portion control, social interactions, and cognitive strategies) followed a clear linear trend across stages of change for healthful eating. Strategy use was more strongly related to stage than energy intake, fat intake, and fruit and vegetable servings as measured via food frequency questionnaire. Baseline stage of change showed some relationship to change in strategy use over time, although most group differences were not statistically significant., Conclusions: Use of a range of behavioral strategies is strongly related to stage of change for healthful eating, and more closely associated with stage than dietary intake. In the absence of intervention, baseline stage only weakly predicted changes in strategy use. Programs with the goal of encouraging a range of healthful eating behaviors may find these measures of strategy use to be helpful in defining stage of change, and possibly in tracking behavior change over time.

Reducing red meat intake to lower serum cholesterol may also lower iron and zinc intake. Eighty-six seventh and eighth graders who enrolled in a study comparing serum ferritin, zinc, and cholesterol levels were randomized to a low-fat eating pattern emphasizing either lean beef or lean poultry and fish. Serum data and three 24-hour recalls were collected at baseline and 3 months. The lean beef group ate significantly more beef [26 (4, 37) g/d; P<.01] and both groups reduced total and saturated fat intake. Although serum ferritin level change between baseline and intervention was significantly different between the lean beef and lean poultry and fish groups (median [interquartile range] 0.7 [-6, 8] and -6.8 [-12, 2] microg/dL, respectively), the drop in the lean poultry and fish group was not clinically significant. No differences were observed in iron and zinc intake or in serum zinc and cholesterol levels. Teenagers eating diets low in saturated fat may benefit from adequate amounts of lean red meat.

Objectives: Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA1c); compare patient satisfaction with care and perceptions about quality of life., Design: Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA1c levels, and patient satisfaction and perceptions about quality of life., Subjects/settings: Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods., Statistical Analysis: chi 2 Test, t test, and analysis of covariance., Results: Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA1c improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA1c level than usual care patients (-1.00 vs -0.33). This difference was statistically significant and clinically meaningful., Conclusions/applications: Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care of perceived quality of life.

As part of an intensive treatment regimen that had as its goal achieving and maintaining blood glucose levels in the normal range in individuals with insulin-dependent diabetes mellitus, dietitians in the Diabetes Control and Complications Trial implemented varying nutrition intervention strategies to counsel patients to attain normoglycemia. Dietary management encompassed recommendations on altering insulin dosages for varying food intake. Nutrition intervention was tailored to best meet a participant's life-style, motivation, ability to grasp information, diet history, and specific intensive insulin therapy. Dietitians were integral participants in the team management of individuals in the intensive treatment group. Selected nutrition interventions--Healthy Food Choices, exchange systems, carbohydrate counting, and total available glucose--and behavior management approaches were coupled with intensive insulin therapy. Case presentations illustrate each nutrition intervention in the attainment of normoglycemia.

The purpose of the workshop on nutrition counseling was twofold: (a) to enhance nutritionists' and dietitians' knowledge of counseling and basic interviewing skills, behavioral weight control counseling skills, and adherence counseling skills and (b) to quantitatively evaluate improvement and maintenance of the newly acquired skills. Changes in these areas indicated that it is possible to improve certain skills and to maintain those improvements over time.