do clients with hepatitis C at the oasis program in ottawa meet their nutrient needs?

1. do clients with hepatitis C at the oasis program in ottawa meet their nutrient needs? by carol holland the ottawa hospital dietetic internship july 17, 2008

2. outline • introduction of the project • procedures and methods • results & discussion • nutrients and food • food insecurity • limitations to the project • recommendations for action

3. hepatitis C • 250,000 canadians live with HCV • injection drug use • 50%-85% of infections become chronic • 50% of HCV patients restrict their diet after diagnosis • evidence does not suggest a need for restriction • nutrition therapy goals are individualized • DC: Hepatitis C Nutrition Care: Canadian Guidelines for Health Care Providers

4. the oasis program: sandy hill CHC • clients living with or at risk of HIV or HCV • medical and social services • nutrition services: vitamins, counselling, presentations, cooking workshops

5. food insecurity • definition: “limited or uncertain availability of nutritionally adequate and safe foods; or, limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” www.blog.americanfeast.com

6. inclusion criteria exclusion criteria • diagnosis of hepatitis C by HCV antibody and HCV RNA test • clients with medical records at the oasis program • ability to come to the clinic for an interview • no diagnosis of HCV • no previous medical examination • co-infection with HIV recruitment

7. procedures and methods • chart review • individual interviews • consideration of supplementation • Household Food Insecurity Access Scale • qualitative questions • nutrient analysis • one-sample t-tests

8. requirements met requirements not met • energy (kcal) • CHO • vitamins • K (female) • C • thiamine (female) • niacin • B6 • minerals • Mg (female) • Zn (female) • Fe (male) • protein • fibre • vitamins • A (female) • E • folic acid • minerals • Mg (male) • Ca (19-50) • Zn (male) • Fe (female) results

9. number of recommended servings from CFG food groups compared to subjects’ intake

10. accepted serum nutrient ranges compared to subjects’ serum levels

11. HFIAS • category: • 11 subject • 2 1 subject • 3  2 subjects • 4  8 subjects • 67% reported severe food insecurity www.active.com/donate/acrescuemission/cumc

12. additional qualitative questions • where do you get your food? • do you cook your own food? • if not, who cooks for you? • where do you usually eat? • where do you live? • have you ever taken herbal medicines for HCV? • if yes, what were they and who recommended them to you?

13. limitations • incomplete medical charts • addictions • nutrient analysis software • honorarium required for participation • socially disadvantaged population • n=12 • 24 hour diet recall

14. future research • larger population • wider range of social demographics • “healthy” HCV populations • nutritional implications of long-term HCV infection and food insecurity • evaluate link between food security & housing

15. conclusions recommendations • DC guidelines not met • CFG recommendations not met • serum levels within range • food insecurity a major problem • consider supplementation • free multivitamins • healthy “to go” snacks • new strategies & partnerships to address food insecurity summary

16. questions? www.hepcandme.org