Journal of the American Dietetic Association, 1998
As foods from genetically enhanced seeds or from animals treated with recombinant hormones enter ... more As foods from genetically enhanced seeds or from animals treated with recombinant hormones enter the market, it is important that registered dietitians (RDs) have knowledge and attitudes about this technology based on scientific research. Baseline studies indicate RDs in New York and Iowa have limited knowledge of foods derived from genetic engineering (GE) or of regulations in place to ensure
BACKGROUND Given the rising rates of obesity there is a pressing need for medical schools to bett... more BACKGROUND Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts. OBJECTIVE To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change. DESIGN A pair-matched, group-randomized controlled trial (2015-2020) included students enrolled in eight U.S. medical schools randomized to receive either multi-modal weight management education (MME) or traditional weight management education (TE). SETTING/PARTICIPANTS Students from the class of 2020 (N=1305) were asked to participate in an objective structured clinical examination (OSCE) focused on weight management counseling and complete pre and post surveys. A total of 70.1% of eligible students (N=915) completed the OSCE and 69.3% (N=904) completed both surveys. INTERVENTIONS: The MME implemented over three years included a web-based course, a role-pl...
OBJECTIVE: To determine environmental factors associated with Nodding Syndrome (NS), a treatable ... more OBJECTIVE: To determine environmental factors associated with Nodding Syndrome (NS), a treatable but otherwise progressive form of epilepsy in east Africa. BACKGROUND: Uncontrollable head nodding, often food-associated, was first described in Tanzania in the 1960s, with reports from 1934 (Afr. Health Sci. 13: 176-82, 2013). Many develop generalized seizures. Large outbreaks of NS occurred in South Sudan (from 1991) and Uganda (from 1997), the latter affecting thousands of children. Common risk factors include population ..
Journal of child nutrition & management (Online), 2011
The purpose of this study is to report the impact of the three-year middle school-based HEALTHY s... more The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar. Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburg, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n=21 schools) or control (n=21 schools) groups, with three intervention and three control schools per city. All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study, in 2009. The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study, using the Pearson chi-square test statistic. At baseline, 15 interve...
Background: A nutrient-rich diet during pregnancy is critical to optimize gestation and birth out... more Background: A nutrient-rich diet during pregnancy is critical to optimize gestation and birth outcomes. The PEN program, a team-based, peer-led, 20-session curriculum was used to promote healthy dietary choices and activity during pregnancy to reduce gestational diabetes risk. Methods: The Healthy Eating Index (HEI) and the Diet Quality Index for Pregnancy (DQI-P) were used to assess diet quality of 14 control (CG) and 12 intervention (IG) participants based on food intake measured by the Automated Self-Administered-24 Hour Dietary Recall. Mean changes in HEI and DQI-P scores from baseline (BL) to the 2nd and 3rd trimesters (T) were calculated and differences within and between groups were determined using t-tests. Results: Although no significant differences or changes in mean total HEI or DQI-P scores were observed between groups at BL, T2, or T3, added sugar consumption was 47.9% lower in the IG (8.7 ± 8.2 tsp-equivalent) than the CG (16.7 ± 10.6 tsp-equivalent) at T3 (P=0.045). Mean DQI-P fruit score,...
Background: Dietary fat intake influences glucose control during pregnancy. Methods: Fasting gluc... more Background: Dietary fat intake influences glucose control during pregnancy. Methods: Fasting glucose (FG) and insulin (FI) were measured, insulin resistance and sensitivity (HOMA-IR, HOMA-β, and QUICKI) were calculated and dietary total fat (TF), saturated fat (SFA), monounsaturated fat (MUFA), and polyunsaturated fat (PUFA) were estimated each trimester (T1, T2, T3) in 26 women during pregnancy. Relationships between fat intake and glucose control were assessed using canonical correlations (CC). Results: Compared to sample means, during T1, higher MUFA, PUFA and lower SFA intakes are correlated with higher QUICKI and FI (r=0.72); higher TF, SFA, and MUFA intakes are correlated with higher FG (r=0.67). During T2, higher TF and SF intakes are correlated with higher FG, FI, HOMA-IR, HOMA-β and lower QUICKI (r=0.66). During T3, higher TF, MUFA, and PUFA intakes are correlated with lower FI, HOMA-IR, HOMA-β, and high QUICKI (r=0.65). Fat Variables T1 CC1 T1 CC2 T2 CC1 T3 CC1 Correlation between Variables and ...
Educating and training a multisectoral food systems workforce is a critical part of developing su... more Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the...
Objectives In Lao PDR, 33.5% of children <5 years are stunted, 26% are underweight and 8% are ... more Objectives In Lao PDR, 33.5% of children <5 years are stunted, 26% are underweight and 8% are severely wasted. Nutritional rehabilitation of malnourished children often requires dietary protein (PRO) and energy supplementation. Water buffalo (WB) native to SE Asia produce milk with more fat and PRO than dairy cow (DC) milk. Although WB milk is not typically consumed in Lao, it is used to make cheese. Whey, a byproduct of cheese production and a source of PRO and energy, is currently discarded in Lao. We analyzed and compared energy and macronutrient concentrations of WB milk and liquid and dried acid whey to DC milk and acid whey data in the 2020 USDA nutrient database to determine potential as a locally-sourced protein supplement. Methods WB milk and whey samples were obtained from the Lao Buffalo Dairy in Lao PDR. Nutrient analysis was performed by Mahidol University, Bangkok, Thailand. Crude PRO and fat concentrations were measured by Kjeldahl and Soxtec™ technology, respectiv...
Objectives Malnutrition is the number one health priority in Lao PDR where 36% of children under ... more Objectives Malnutrition is the number one health priority in Lao PDR where 36% of children under the age of five are stunted and 27% are underweight. Compounded by escalating rates of diabetes and non-communicable diseases, hospital-based nutrition interventions are needed. A partnership between OHSU and the Lao Ministry of Health is working to fill the gap in knowledge and application by providing clinical nutrition education to health care providers. Methods A clinical nutrition needs assessment was conducted in early 2016 and informed the design of a 1000-hour, evidenced-based applied clinical dietetics certificate program for health professionals. Aligning with the 2015 International Dietitian Education Program (IDE) standards, the curriculum was adapted to be culturally relevant and appropriate. Semi-structured interviews, open-ended questions, and pre-and post-tests were used to evaluate the program. Results As of January 2020, 32 clinicians have successfully completed the pro...
We examined the effect of macronutrient content on glomerular filtration rate (GFR), and excretio... more We examined the effect of macronutrient content on glomerular filtration rate (GFR), and excretion, reabsorption, and filtered load of carnitine. Ten subjects consumed five diets [high protein (HP), low protein (LP), control, high fat (HF), and high carbohydrate (HC)] of equal energy and carnitine content for 6 d each, in a randomized crossover manner. The rate of carnitine excretion was lower after the LP diet than after the HP diet because of lower GFR after the LP diet. The rate of carnitine reabsorption was lower after the LP diet than after the HP diet, also because of the lower GFR after the LP diet. The rate of carnitine reabsorption was not different after the HF and HC diets, nor was GFR. The filtered load of carnitine, however, was greater after the HF diet, resulting in a higher rate of carnitine excretion.
Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to p... more Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools. Weight Management Counseling in Medical Schools: A Randomized Controlled Trial (MSWeight) is designed to determine if a multi-modal theoretically-guided WMC educational intervention improves observed counseling skills and secondarily improve perceived skills and self-efficacy among medical students compared to traditional education (TE). Eight U.S. medical schools were pair-matched and randomized in a group randomized controlled trial to evaluate whether a multi-modal education (MME) intervention compared to traditional education (TE) improves observed WMC skills. The MME intervention includes innovative components in years 1-3: a structured web-course; a role play exercise, WebPatien...
Journal of the American Dietetic Association, 1998
As foods from genetically enhanced seeds or from animals treated with recombinant hormones enter ... more As foods from genetically enhanced seeds or from animals treated with recombinant hormones enter the market, it is important that registered dietitians (RDs) have knowledge and attitudes about this technology based on scientific research. Baseline studies indicate RDs in New York and Iowa have limited knowledge of foods derived from genetic engineering (GE) or of regulations in place to ensure
BACKGROUND Given the rising rates of obesity there is a pressing need for medical schools to bett... more BACKGROUND Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts. OBJECTIVE To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change. DESIGN A pair-matched, group-randomized controlled trial (2015-2020) included students enrolled in eight U.S. medical schools randomized to receive either multi-modal weight management education (MME) or traditional weight management education (TE). SETTING/PARTICIPANTS Students from the class of 2020 (N=1305) were asked to participate in an objective structured clinical examination (OSCE) focused on weight management counseling and complete pre and post surveys. A total of 70.1% of eligible students (N=915) completed the OSCE and 69.3% (N=904) completed both surveys. INTERVENTIONS: The MME implemented over three years included a web-based course, a role-pl...
OBJECTIVE: To determine environmental factors associated with Nodding Syndrome (NS), a treatable ... more OBJECTIVE: To determine environmental factors associated with Nodding Syndrome (NS), a treatable but otherwise progressive form of epilepsy in east Africa. BACKGROUND: Uncontrollable head nodding, often food-associated, was first described in Tanzania in the 1960s, with reports from 1934 (Afr. Health Sci. 13: 176-82, 2013). Many develop generalized seizures. Large outbreaks of NS occurred in South Sudan (from 1991) and Uganda (from 1997), the latter affecting thousands of children. Common risk factors include population ..
Journal of child nutrition & management (Online), 2011
The purpose of this study is to report the impact of the three-year middle school-based HEALTHY s... more The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar. Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburg, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n=21 schools) or control (n=21 schools) groups, with three intervention and three control schools per city. All items in vending machine slots were tallied twice in the fall of 2006 for baseline data and twice at the end of the study, in 2009. The percentage of total slots for each food/beverage category was calculated and compared between intervention and control schools at the end of study, using the Pearson chi-square test statistic. At baseline, 15 interve...
Background: A nutrient-rich diet during pregnancy is critical to optimize gestation and birth out... more Background: A nutrient-rich diet during pregnancy is critical to optimize gestation and birth outcomes. The PEN program, a team-based, peer-led, 20-session curriculum was used to promote healthy dietary choices and activity during pregnancy to reduce gestational diabetes risk. Methods: The Healthy Eating Index (HEI) and the Diet Quality Index for Pregnancy (DQI-P) were used to assess diet quality of 14 control (CG) and 12 intervention (IG) participants based on food intake measured by the Automated Self-Administered-24 Hour Dietary Recall. Mean changes in HEI and DQI-P scores from baseline (BL) to the 2nd and 3rd trimesters (T) were calculated and differences within and between groups were determined using t-tests. Results: Although no significant differences or changes in mean total HEI or DQI-P scores were observed between groups at BL, T2, or T3, added sugar consumption was 47.9% lower in the IG (8.7 ± 8.2 tsp-equivalent) than the CG (16.7 ± 10.6 tsp-equivalent) at T3 (P=0.045). Mean DQI-P fruit score,...
Background: Dietary fat intake influences glucose control during pregnancy. Methods: Fasting gluc... more Background: Dietary fat intake influences glucose control during pregnancy. Methods: Fasting glucose (FG) and insulin (FI) were measured, insulin resistance and sensitivity (HOMA-IR, HOMA-β, and QUICKI) were calculated and dietary total fat (TF), saturated fat (SFA), monounsaturated fat (MUFA), and polyunsaturated fat (PUFA) were estimated each trimester (T1, T2, T3) in 26 women during pregnancy. Relationships between fat intake and glucose control were assessed using canonical correlations (CC). Results: Compared to sample means, during T1, higher MUFA, PUFA and lower SFA intakes are correlated with higher QUICKI and FI (r=0.72); higher TF, SFA, and MUFA intakes are correlated with higher FG (r=0.67). During T2, higher TF and SF intakes are correlated with higher FG, FI, HOMA-IR, HOMA-β and lower QUICKI (r=0.66). During T3, higher TF, MUFA, and PUFA intakes are correlated with lower FI, HOMA-IR, HOMA-β, and high QUICKI (r=0.65). Fat Variables T1 CC1 T1 CC2 T2 CC1 T3 CC1 Correlation between Variables and ...
Educating and training a multisectoral food systems workforce is a critical part of developing su... more Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the...
Objectives In Lao PDR, 33.5% of children <5 years are stunted, 26% are underweight and 8% are ... more Objectives In Lao PDR, 33.5% of children <5 years are stunted, 26% are underweight and 8% are severely wasted. Nutritional rehabilitation of malnourished children often requires dietary protein (PRO) and energy supplementation. Water buffalo (WB) native to SE Asia produce milk with more fat and PRO than dairy cow (DC) milk. Although WB milk is not typically consumed in Lao, it is used to make cheese. Whey, a byproduct of cheese production and a source of PRO and energy, is currently discarded in Lao. We analyzed and compared energy and macronutrient concentrations of WB milk and liquid and dried acid whey to DC milk and acid whey data in the 2020 USDA nutrient database to determine potential as a locally-sourced protein supplement. Methods WB milk and whey samples were obtained from the Lao Buffalo Dairy in Lao PDR. Nutrient analysis was performed by Mahidol University, Bangkok, Thailand. Crude PRO and fat concentrations were measured by Kjeldahl and Soxtec™ technology, respectiv...
Objectives Malnutrition is the number one health priority in Lao PDR where 36% of children under ... more Objectives Malnutrition is the number one health priority in Lao PDR where 36% of children under the age of five are stunted and 27% are underweight. Compounded by escalating rates of diabetes and non-communicable diseases, hospital-based nutrition interventions are needed. A partnership between OHSU and the Lao Ministry of Health is working to fill the gap in knowledge and application by providing clinical nutrition education to health care providers. Methods A clinical nutrition needs assessment was conducted in early 2016 and informed the design of a 1000-hour, evidenced-based applied clinical dietetics certificate program for health professionals. Aligning with the 2015 International Dietitian Education Program (IDE) standards, the curriculum was adapted to be culturally relevant and appropriate. Semi-structured interviews, open-ended questions, and pre-and post-tests were used to evaluate the program. Results As of January 2020, 32 clinicians have successfully completed the pro...
We examined the effect of macronutrient content on glomerular filtration rate (GFR), and excretio... more We examined the effect of macronutrient content on glomerular filtration rate (GFR), and excretion, reabsorption, and filtered load of carnitine. Ten subjects consumed five diets [high protein (HP), low protein (LP), control, high fat (HF), and high carbohydrate (HC)] of equal energy and carnitine content for 6 d each, in a randomized crossover manner. The rate of carnitine excretion was lower after the LP diet than after the HP diet because of lower GFR after the LP diet. The rate of carnitine reabsorption was lower after the LP diet than after the HP diet, also because of the lower GFR after the LP diet. The rate of carnitine reabsorption was not different after the HF and HC diets, nor was GFR. The filtered load of carnitine, however, was greater after the HF diet, resulting in a higher rate of carnitine excretion.
Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to p... more Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools. Weight Management Counseling in Medical Schools: A Randomized Controlled Trial (MSWeight) is designed to determine if a multi-modal theoretically-guided WMC educational intervention improves observed counseling skills and secondarily improve perceived skills and self-efficacy among medical students compared to traditional education (TE). Eight U.S. medical schools were pair-matched and randomized in a group randomized controlled trial to evaluate whether a multi-modal education (MME) intervention compared to traditional education (TE) improves observed WMC skills. The MME intervention includes innovative components in years 1-3: a structured web-course; a role play exercise, WebPatien...
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Papers by Diane Stadler