Computer Applications in Nutrition & Dietetics

An Annotated Bibliography

John Orta

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781135802974
• Topic: Medicina
• Subtopic: Atención sanitaria

First Published in 1988. Over the past three decades there have been significant advances in the role of computers in nutrition and dietetics. Despite numerous published articles and theses, very few books devoted to the subject exist. A selective yet representative sample of published materials related to computer applications in nutrition and dietetics are summarized in this book. This work covers the literature published between 1958 and 1987 related to computer applications in nutrition and dietetics. The majority of the citations are from professional journals.

CHAPTER I

NORMAL NUTRITION

INTRODUCTION

Nutrition is the study of food relative to human health. Normal nutrition encompasses the study of human energy needs and nutrient requirements, physical and chemical properties, functions, utilization, food sources, recommended allowances and the results of nutrient deficiencies on the human organism. Additional areas of study in normal nutrition include body composition, dietary guides and their applications, meal patterns and food habits, and nutritional needs throughout the life cycle.

1.  Balintfy, Joseph, L., and Lilly M. Lancaster. “Computing ‘Best Fit’ Calorie-Controlled Diet Patterns by Microcomputer.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 87 (January 1987): 71-73.

Calculation of meal patterns using the exchange list method is adaptable to computerization. The general problem is to determine the number of exchanges from each exchange group in order to derive a meal pattern that satisfies prescribed nutritional goals. There are many meal patterns that may meet a given set of nutritional goals. However, the problem is not fully defined unless a criterion is available to choose one out of several nutritionally adequate meal patterns. An early attempt at computing “best fit” diets is described in item 42.

The authors identified “desired pattern” as the criteria. This led to the problem of finding the “best fit” to the desired meal pattern that satisfies nutrient goals. Motivated by the work of Suitor et al. cited in item 46 the authors approached the problem mathematically and computationally. They wrote and described a BASIC microcomputer program for the IBM Personal Computer designed to find diet patterns that “best fit” individually desired nutritional constraints.

2.  Caster, W.O. “Use of a Digital Computer in the Study of Eating Habit Patterns.” AMERICAN JOURNAL OF CLINICAL NUTRITION 10 (February 1962): 98-106.

Among the most valuable information that a nutritionist can possess is knowledge of the factors that affect food consumption. One of the earliest published reports on the use of digital computers in nutrition dealt with the study of eating habits. An ambitious attempt was made to use computers in a study designed to sort out the multiple variables impacting on food consumption patterns among individuals and groups. It was reasoned that with the aid of modern digital computers the time was ripe to conduct studies on food consumption records more detailed than had previously been practical. The speed and ease with which statistical results could be obtained were cited as advantages of using computers.

Caster concluded that available statistical methods, with the aid of computers, could be applied to large volumes of data about the usual food consumption patterns of a group of individuals. From processing such data, a fairly accurate picture of the eating patterns of different persons within the group could be derived. Such techniques would allow identification of individuals whose eating patterns deviate in a significant way, and direct attention to the extent of such differences. Additionally, such procedures suggest ways to plan and interpret dietary survey data.

3.  Cleveland, Linda E., and Andrea B. Pfeffer. “Planning Diets to Meet the National Research Council’s Guidelines for Reducing Cancer Risk.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 87 (February 1987): 162-168.

A computerized quadratic programming model was used to develop diets for American adults meeting the criteria set by the Recommended Dietary Allowances (RDAs) and the National Research Council’s interim guidelines for reducing cancer risk. The potential impact of such dietary changes on nutrient levels and costs were analyzed. Diets were planned using data from the United States Department of Agriculture’s 1977-1978 Nationwide Food Consumption Survey and a computerized model that minimized deviations from average consumption patterns while meeting the RDAs. The computer model permitted an appraisal of the effect of modifying variables to fit specified constraints.

4.  Foytik, Jerry. “Very Low-Cost Nutritious Diet Plans Designed by Linear Programming.” JOURNAL OF NUTRITION EDUCATION 13 (June 1981): 63-66.

Foytik used linear programming, a mathematical technique for breaking problems down into a form amenable to computer solution, to determine its usefulness in designing low-cost nutritionally adequate dietary guidelines. These were intended for low-income groups and others wishing to cut their household food expenses to a level below that of the United States Department of Agriculture’s Thrifty Food Plan.

The author assumed that some consumers would be willing to change their eating patterns in order to consume nutritious, low-cost foods. However, people do not select foods on the basis of discrete attributes such as cost or nutrition. They think of foods holistically. It is naive to assume that a number of variables programmed into a computer will generate a consumable diet plan. This item is contested in item 10.

5.  Hayes, Olive B., Sidney Abraham, and Cesar A. Caceres. “Computers in Epidemiologic Dietary Studies.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 44 (June 1964): 456-460.

These workers argued for the use of computers in epidemiologic studies when working with exceptionally large volumes of data, requiring lengthy and repetitive data processing, involving complex statistics or extensive classification, and speed for data analysis. Hayes and colleagues observed that using computers in epidemiologic studies of cardiovascular disease provided three advantages, including (a) improved data comparability, (b) easier adaptation of innovative approaches to the analysis of dietary data, and (c) greater efficiency of data storage for future use. These workers concluded that the computer was a useful new tool available for epidemiologic dietary research.

6.  Katch, F.I., and V.L. Katch. “Computer Technology to Evaluate Body Composition, Nutrition, Exercise.” PREVENTIVE MEDICINE 12 (1983): 619-631.

Researchers used computers to evaluate body composition, nutrition and exercise. They devised a computerized system called, FITCOM (an acronym for fitness by computer). It evolved from a need to provide a rapid system of data analysis for various professional sports teams and world-class athletes. The system generated reports related to body composition, meal plans, and exercise programs. Its practicality stemmed from its capacity to be used interactively to plan menus and exercises based on individual preferences. Heretofore, the norm was to plan menus and exercises first and then proceed to follow the plan. Also, FITCOM obviated the need to perform the tedious manual calculations required to individualize an exercise and nutrition plan.

FITCOM’s interactive computer-based technology was valuable because of its thoroughness and speed. For example, an individualized 16-page report considering such factors as body composition, body size, sex, age, activity preference, and current fitness levels could be generated in ten seconds. The authors concluded that such reports could greatly enhance the quality of health services.

7.  Pao, Eleanor M., and Marguerite C. Burk. “A Computer-Assisted Approach to Meal Patterning.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 65 (August 1974): 144-150.

The United States Department of Agriculture periodically conducts food consumption surveys. It would be helpful if researchers who undertake such studies had methods that would facilitate the job. These investigators were involved in research to organize and code food combinations into meal patterns. They reported on a computer-assisted approach to meal classification based on combinations of foods and the application of a meal patterning scheme to dietary data obtained from a 1965 survey of groups from two regions of the United States—North Central and South. The approach made extensive use of computer programs. It accomplished the following: (a) grouped foods within meal patterns, (b) combined these components into meal patterns, and (c) coded the patterns. These researchers suggested that their work was useful to nutritionists and dietitians because meal patterning data could be used to investigate relationships between variables such as (a) food intake, meal frequency, and obesity; (b) food intake, fat and heart disease; and (c) food intake, additives, and toxicity.

Pao and Burk stated that further research along these lines were under way. It involved developing procedures to relate single meal patterns to (a) the day’s food patterns, (b) the socioeconomic characteristics of the individuals’ studied, and (c) the day’s nutrient intake pattern.

8.  Sawicki, Marjorie, and Jeannette Endres. “Energy and Nutrient Calculations Using an Optical Character Reader System.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (February 1983): 135-141.

A new application of the Optical Character Reader (OCR) technology in dietetics was used to tabulate dietary data, and to calculate energy and nutrient values from dietary records.

The authors analyzed 30 one-day dietary records. They employed three different procedures: manual, online computerized, and the new OCR technology. A comparison was made of the results of the tabulations, length of time to execute the tasks, and costs. No significant difference was found in the results of the calculations among the three methods used to determine energy and nutrient values. There was, however, a significant difference in the time required to calculate dietary records. The most time-consuming was the hand calculations, followed by the online computerized method, and the OCR method. Similarly, there was a significant difference in terms of costs, the manual method being the most costly. The cost of the manual method was found to be twice that of the online method and four times the cost of the OCR method.

Although the OCR technology yielded reproducible results, obviated the need for in-house computer facilities, and outperformed the two alternative methods in terms of time and costs, this system required that the dietary records be sent to a central facility for processing. The turnaround time to obtain the results was 7 to 10 days. Obviously this would reduce the utility and the timeliness of a dietary evaluation, which is often needed immediately to provide effective patient counseling. Notwithstanding, the technology showed great potential for other applications in nutrition.

9.  Thompson, Ethel M., and Henry Tucker. “Computers in Dietary Studies.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 40 (April 1962): 308-312.

It was reasoned that time and costs were limiting factors in the number of diets that could be evaluated by conventional methods, that is, using pencil-and-paper procedures and desktop calculators. They reported that the arrival of low-cost, high-speed computing simplified the process of calculating the nutritive values of diets. Additionally, they speculated that computing capabilities could be extended to furnish simultaneous information, along with the results of the dietary analyses, at minimal additional cost. Such information would include factors that impact on dietary selection including nutritional recommendations, food cost data, personal income, and occupation.

These researchers also theorized that eventually computers could simultaneously consider other variables like palatability, digestibility, and evaluation of nutrition status as a function of a changing diet. Thompson and Tucker reported that the limiting factor in the use of computers in many areas was the relatively high initial cost of preparing data processing (input) cards. Nonetheless, these researchers were optimistic that advances in the use of computers would greatly accelerate development of new techniques with which to measure human health.

10.  Woteki, C.E. “Low-Cost Nutritious Diet Plans—A Commentary.” JOURNAL OF NUTRITION EDUCATION 13 (June 1981): 66.

Woteki rebutted Foytik’s linear programming model (item 4) arguing that a more promising route seemed to be interactive computing systems. In such a system, the person who would ultimately use the diet plan would input the data and include palatability constraints. That is, the household food manager would select those constraints that constitute the minimum essentials of an acceptable diet plan. In this fashion, a diet plan could be individualized to address the needs and food preferences of the household.

There is an important lesson in all of this. First, Foytik viewed the problem from an agricultural economics perspective. In terms of generating acceptable diet plans, it takes more than just delimitation of a few constraints, linear programming, and a computer: it requires a knowledge base encompassing the many complex determinants of human food selection. Secondly, planning an eating strategy using interactive computing systems is more likely to be successful when constraints include not only nutrition and cost factors, but palatability factors as well, that is, including nutritious foods that are widely acceptable across all segments of the population. To accomplish this requires greater input by those familiar with the factors that affect eating patterns, nutrition, and computing capabilities. This implies that nutritionists should become more conversant with computing in order to execute their work more effectively and professionally.

CHAPTER II

CLINICAL NUTRITION

INTRODUCTION

Clinical or therapeutic nutrition deals with dietary modifications to fit the needs of individuals with pathological conditions. The area of study encompasses first, assessment of the nutritional status of individuals through the collection of dietary information, appraisal of physical findings, and laboratory measurements; and second, the comprehensive nutritional management of diseases arising from abnormal conditions with nutritional implications, including disorders of all major bodily systems. Modifications of the normal diet often requires changes in the consistency of the diet, the frequency and amount of food allowed, and nutrient levels. Moreover, a major concern in the nutritional management of diseases is the potential for adverse drug-nutrient interactions. Such may involve the effects of drugs on nutrient absorpiton and metabolism, and/or the effects of foods on drug absorption and utilization. Additionally, proper nutritional care in disease requires careful patient management and counseling. Effective interviewing, development of individualized diet plans, adaptation of counseling to the patients’ lifestyles and needs, documentation in the medical records, follow-up, and evaluation of the nutritional care plans are the hallmarks of effective nutritional care. The third major area involved in clinical nutrition is the nutritional support of the critically ill patient, which entails the technology of alternative feeding modalities, including tube and parenteral feedings. Finally, the fourth area of study in clinical nutrition is quality assurance and peer review of the professional performance of nutritionists and dietitians in accordance with pre-established guidelines for the nutritional management of patients afflicted with various diseases.

GENERAL REFERENCES

11. Bell, Louise. “Computer Applications in Clinical Dietetics in Canada: Why Should We Recreate the Wheel?” JOURNAL OF DIETETIC SOFTWARE 1 (Summer 1984): 3, 4, 6.

Computer applications for the calculation of nutrient intakes are relatively few in Canada as compared to the United States. Therefore, Canadian nutrition professionals are in a position to study and evaluate the problems that the more technologically advanced American nutritionists have faced in developing computer applications in clinical dietetics.

Past unsuccessful efforts by Canadian workers included development of computerized models which were not transferable because of hardware incompatibility from one brand to another. Technology has advanced to minimize such problems today. In 1980 Agriculture Canada undertook an assessment of nutrient data bases which led to the development of the Canadian Nutrient File. It will be the basis for the data banks to be used in Canadian public health programs, dietary surveys, research studies, teaching and clinical dietetics. Limitations of the system are: (a) nutrient files lack many foods, and (b) many special foods used in clinical dietetics are excluded.

One of the major advantages cited for establishing a central nutrient file system is that it would allow professionals access to comprehensive and reliable nutrient data without duplication of efforts associated with creating individual data banks. Notwithstanding, differences between the data bases in various nations, their reliability, and features were discussed as elements to examine when considering establishing a Canadian national nutrient data file.

12. Danford, Darla E. “Computer Applications in Clinical Nutrition.” NORMAL AND THERAPEUTIC NUTRITION. 17th ed. Chapter 44. Robinson, Corrine, Marilyn R. Lawler, Wanda L. Chenoweth, and Ann E. Garwick. New York: Macmillan, 1986, 612-620.

Students of nutrition, dietetics and other health workers are urged to learn to integrate computer applications into their practice in order to enhance their professional performance. Danford reviews computer applications in clinical nutrition focusing primarily on their use in nutritional assessment and nutrition education. This is significant because, along with item 12, this chapter is part of a trend to include a textbook chapter on computer applications in the relevant branch of the discipline. In this case clinical nutrition.

Computer use in nutritional assessment delineated are: (a) anthropometric and body composition measurements, (b) clinical assessment, (c) biochemical assessment, and (d) dietary assessment. Moreover, computer applications related to diet counseling, interview techniques, planning nutritional care, bedside monitoring, charting and follow-up, research, and home health care are presented.

Different aspects of computer-assisted instruction in the discipline are described. These encompass elementary to college education, dietetic internships, and consumer education. Predictions are made about the future of computers in the discipline along with a word of caution on the potential misuse of the technology.

13. Williams, Sue R. “Computers in the Management of Nutritional Practice.” NUTRITION AND DIET THERAPY. 5th ed. Chapter 31. St. Louis, Missouri. Times Mirror/Mosby College Publish...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Preface
• Acknowledgments
• Chapter I. Normal Nutrition
• Chapter II. Clinical Nutrition
• Chapter III. Community Nutrition
• Chapter IV. Management
• Chapter V. Food Service Operations
• Chapter VI. Computer-Based Education in Nutrition and Dietetics
• Indexes