LAURA MAYDAK JULIANA MUSMANNO ERIN LONG AMANDA BRIGHT

1. The disability experience conference: Theoretical and Experiential perspectives on nutrition in the disability experience LAURA MAYDAK JULIANA MUSMANNO ERIN LONG AMANDA BRIGHT

2. Background • The effect of disability and nutrition on one another is often overlooked • Socioeconomic, mental, physical, and emotional disabilities affect one’s nutritional status and needs • Relevant experiences of students in University of Pittsburgh's Coordinated Master in Nutrition & Dietetics (CMD) will be highlighted • The critical role of a Registered Dietitian (RD) in aiding persons with disabilities will be addressed

3. Investigating nutrition & the disability experience • Involvement in community-based nutrition events has revealed many populations in need of nutrition-related guidance • Socioeconomic, mental, physical, and emotional disabilities must all be addressed when considering nutrition and the disability experience • A preliminary analysis of select studies was conducted to evaluate the nutritional aspect of the disability experience1-2 • The examination revealed the need for dietetic intervention in the care of individuals with a variety of disabilities

4. The move from a long-stay learning disabilities hospital to community homes: a comparison of client’s nutritional status • Methods: • Nutritional risk screenings were given pre-departure and one year post-departure from a long-stay learning hospital • Results: • Comparison between screenings revealed an increase in overall risk relating to food groups, unintentional weight gain and loss, and overall risk relating to weight • Conclusion: • This population is at risk for nutrition-related problems when living independently • Nutritional intervention provided by an RD would produce more favorable outcomes relating to health status and overall quality of life 1

5. prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study • Method: • Validated questionnaire was sent to parents children with oromotor dysfunction • Results • Respondents included a wide range of disabilities • Gastrointestinal and feeding problems were common • The feeding process was described as stressful and unenjoyably • Conclusion: • Concern regarding nutritional status was revealed • 64% of children had never had a feeding- or nutrition-related assessment 2

6. Mainstay life services • Independent study (University of Pittsburgh Coordinated Masters in Nutrition & Dietetics) • Pilot project for development and implementation of healthy cooking classes for caretakers and disabled individuals at Mainstay Life Services, an assisted living facility • Nonprofit organization that provides residential services to individuals with developmental disabilities • 24-hour full care homes • Semi-independent living • Supported living (less than 30 hours/week of assistance) • 165 individuals in 59 homes throughout Allegheny County

7. Mainstay life services • Taught healthy cooking classes to disabled individuals and staff members • Understand and accommodate specific needs of this population • Tailor teaching methods for this group • Comfort in familiarity and fear what is unknown • Not open to trying new things no matter what the health benefit • Easy recipes that they can make for themselves on their own • Nothing too complicated or with a lot of ingredients

8. Mainstay life services • How can a Registered Dietitian (RD) help? • Include nutritious ingredients in common recipes • Recipe substitutions (Greek yogurt example) • Effectively work with this population to incorporate nutrition and understand the basic essentials to a healthy lifestyle

9. Independent living and chronic conditions: Arthritis • Chronic health conditions can impair the functionality of free-living individuals • Disabling chronic conditions are areas of opportunity for quality of life improvement • Serving the unique nutritional needs of a population can have a positive impact on quality of life • Rheumatoid Arthritis • Osteoarthritis • Applicable research questions posed by members of the arthritic community as well as professionals working in health care

10. Independent living and chronic conditions: Research Results • Review of the available nutrition-based literature • Results from the evidence-based literature review showed potential for dietary interventions in treating symptoms of arthritis3,4,6-9 • Necessity for further research will help to strengthen the findings and allow for subsequent clinical trials to be conducted • Role of the RD in research • Conducting research trials as practicing health care professionals • Holding knowledge of both chronic health conditions and nutrient metabolism • Increasing accessibility to diverse populations through outpatient and community education

11. Conclusion • Each disability has a unique influence upon the affected individual • Registered Dietitians are the credentialed experts able to: • Understand the underlying science and its application in determining the nutritional needs of an individual • Navigate complex motivations (behavioral, genetic, environmental, etc.) behind what, why, and how an individual chooses to eat • Implement evidence-based practices to optimize health and the overall quality of life • The addition of an RD to the medical team is essential to provide individuals with disabilities the best possible healthcare outcomes

12. REFERENCES • 1 Bryan F, Allan T, Russell L. The move from a long-stay learning disabilities hospital to community homes: a comparison of client’s nutritional status. J Hum NutrDietet. 2000;13:265-270. • 2Sullivan P, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P. Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med & Child Neuro. 2000;42:674-680. • 3ScodittiE, Calabriso N, Massaro M, et al. Mediterranean diet polyphenols reduce inflammatory angiogenesis through MMP-9 and COX-2 inhibition in human vascular endothelial cells: A potentially protective mechanism in atherosclerotic vascular disease and cancer. Archives of Biochemistry and Biophysics. 2012;527:81-89. • 4Elkan A, Sjoberg B, Kolsrud B, et al. Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies phosphorlycholine in patients with rheumatoid arthritis: a randomized study. Arthritis Research & Therapy. 2008;10:R34 • 5Your guide to lowering your blood pressure with DASH. U.S. Department of Health and Human Services: National Institute of Health. http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf • 6Nakasone Y, Watabe K, Watanabe K, et al. Effect of a glucosamine-based combination supplement containing chondroitin sulfate and antioxidant micronutrients in subjects with symptomatic knee osteoarthritis: A pilot study. Experimental and Therapeutic Medicine. 2011;2:893-899. • 7Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis. Arthritis & Rheumatism. 2008;10:3183-3191. • 8Caughley GE, James MJ, Proudman SM, et al. Fish oil supplementation increases the cyclooxygenase inhibitory activity of paracetamol in rheumatoid arthritis patients. Complementary Theories in Medicine. 2010;18:171-174. • 9Bahadori B, Uitz E, Thonhofer R, et al. Omega-3 Fatty Acids Infusions as Adjuvant Therapy in Rheumatoid Arthritis. J Parenter Enteral Nutr. 2010;34:151-155. • 10Arthritis Foundation. www.arthritistoday.org