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

by carol hollandthe ottawa hospital dietetic internshipjuly 17, 2008

outlineoutlineintroduction of the projectprocedures and methodsresults & discussion

◦nutrients and food◦food insecurity

limitations to the projectrecommendations for action

hepatitis Chepatitis 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

the oasis program: sandy hill the oasis program: sandy hill CHCCHC

◦clients living with or at risk of HIV or HCV

◦medical and social services◦nutrition services: vitamins, counselling, presentations, cooking workshops

food insecurityfood insecuritydefinition:

“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

recruitmentrecruitment

inclusion criteria exclusion criteriadiagnosis 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

procedures and procedures and methodsmethods

chart reviewindividual interviewsconsideration of supplementationHousehold Food Insecurity Access

Scale qualitative questionsnutrient analysisone-sample t-tests

resultsresults

requirements met energy (kcal) CHO vitamins

◦ K (female)◦ C◦ thiamine (female)◦ niacin◦ B6

minerals◦ Mg (female)◦ Zn (female)◦ Fe (male)

requirements not met protein fibre vitamins

◦ A (female)◦ E◦ folic acid

minerals◦ Mg (male)◦ Ca (19-50)◦ Zn (male)◦ Fe (female)

CFG food group

recommended servings

subjects’ intake

grains 6 – 83.0 ± 0.5 (0 -

5.5)vegetables & fruit 7 – 10

1.7 ± 0.5 (0 - 5.5)

milk & alternatives 2 – 3

1.1 ± 0.4 (0 - 3.5)

meat & alternatives 2 – 3

1.2 ± 0.3 (0 - 3)

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

nutrient

recommended serum levels

subjects' serum levels

albumin 33.0 - 46.0 g/L 40.1 ± 1.1 (37 - 44.3)ferritin 13 - 145 μg/L 97.6 ± 27.9 (28 - 304)RBC folate > 372 nmol/L

1167.9 ± 119.1 (702 - 1725)

vitamin B12 > 131 pmol/L

288.1 ± 39.2 (96 - 486)

vitamin D> 75 - 150

pmol/L 53.3 ± 10.3 (32 - 71)

accepted serum nutrient ranges compared to subjects’ serum levels

HFIASHFIAScategory:

◦11 subject◦2 1 subject◦3 2 subjects◦4 8 subjects

67% reported severe food insecurity

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additional qualitative additional qualitative questionsquestions

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?

limitationslimitationsincomplete medical chartsaddictionsnutrient analysis softwarehonorarium required for

participationsocially disadvantaged populationn=1224 hour diet recall

future research future research larger populationwider range of social demographics“healthy” HCV populations

nutritional implications of long-term HCV infection and food insecurity

evaluate link between food security & housing

summarysummary

conclusions recommendationsDC guidelines not

metCFG

recommendations not met

serum levels within range

food insecurity a major problem

consider supplementation◦ free multivitamins◦ healthy “to go”

snacksnew strategies &

partnerships to address food insecurity

questions?questions?

www.hepcandme.org