GCRC Bionutrition Core

1. GCRC Bionutrition Core

2. What is a Bionutritionist? • A Bionutritionist is a Registered Dietitian (RD) and Licensed Dietitian or Nutritionist (LDN) with extensive knowledge and expertise in the field of nutrition.

3. Bionutrition Services • Protocol development and implementation • Design of nutrient-controlled feeding studies • Anthropometric (i.e. body) measurements • Metabolic assessment • Exercise treadmill testing • Nutrient intake assessment • Behavior modification counseling • Provide meals when appropriate

4. Protocol Development and Implementation • Bionutritionists review protocols received on the GCRC. • The protocol bionutritionist collaborates with the study staff and protocol nurse to develop the Doctors’ Orders, visit templates and other specific protocol documents.

5. Nutrient-Controlled Feeding Studies • Bionutritionists design nutrient-controlled feeding studies. • Feeding studies are conducted to test the relationship(s) between nutrient intake and human physiology. • In such studies, subjects consume only those foods prepared and weighed by the GCRC metabolic kitchen staff. • Subject compliance is monitored.

6. Routine and specialized meals are prepared for subjects on White 13. Metabolic Kitchen

7. Meals/Meal Tickets • Allocation and funding of meals/meal tickets is determined during the protocol review process. • Meals are served on White 13 by the diet techs, who are located in room 1334. • Meal tickets can be obtained from the diet techs or bionutritionists, who are located in room 1303. • Subjects seen at the BIC obtain their meal tickets from the OA at the CNY GCRC front desk.

8. Anthropometric Measurements Bionutrionists measure: • Height and weight to determine BMI. • Frame size to estimate skeletal dimensions. • Circumference measurements of hips, waist, chest, thighs, etc. • Skinfold assessments of tricep, bicep, subscapula and suprailiac.

9. Stadiometer and Scale • A stadiometer and scale are located in the Bionutrition office (room 1303). • Annually, bionutritionists will train you on the correct use of the stadiometer and scale. • A wheelchair scale is located on WHT 13.

10. Circumference and skin fold measurements • Circumference measurementsare determined using a tape measure around certain parts of the body, such as the arms, neck, chest, legs, waist and hips. • Skin fold measurementsrequire the use of calipers to “pinch” or measure several different sites on the body – generally two on an upper arm (“tricep” and “bicep”), one below the shoulder blade (“sub scapular”), and one above the hip (“suprailiac”). The sum of these measurements is then used to estimate total body fat percentage.

11. Bioelectrical Impedance Analysis (BIA) • BIA uses a minute amount of electrical current via electrodes to measure resistance. • Estimates total body water (TBW). • TBW is extrapolated, which provides an estimate of lean body mass and fat mass.

12. Dual Energy X-ray Absorptiometry (DXA) • Determines bone mineral density of spine, hip, arm and whole body. • More accurately assesses body composition, such as lean body mass vs. fat mass. • Used in metabolic studies, such as treatment effect of a medication and/or intervention.

13. Indirect Calorimetry • Metabolic cart assessment estimates energy requirements. • Determines nutrient utilization. • Calculates respiratory quotient (RQ).

14. Indirect Calorimetry • Metabolic Cart Assessments • Sometimes referred to as indirect calorimetry • Used to estimate the number of calories burned (metabolic rate) by the body in a resting state • Completed after an 8- to 12-hour fast (no food or beverages except water) • Subject is instructed to lie down and a clear plastic hood (“canopy”) will be placed over his/her head • For the next 15 to 20 minutes, he/she will simply lie still and breathe normally while the machine collects and analyzes his/her breath .

15. Exercise Treadmill Testing • Determine exercise capacity during sustained physical activity. • Measure oxygen uptake.

16. Nutrient and Other Assessments • Nutrient intake is determined from food recall. • Activity level is assessed through the use of an activity questionnaire or pedometer. • Other questionnaires may include visual analog scales, food preferences, etc.

17. Nutrient and Other Assessments • Food Records • Bionutritionists educate subjects on 4 or 7-day food record completion. A food record is a diary in which the research subject will provide a detailed description of all foods and beverages consumed during that time period. • Questionnaires • Calcium and vitamin D food frequency questionnaires are completed with certain research subjects. Nutrient intake and bionutritionists make recommendations based on protocol specifications. • Activity questionnaires are also completed with certain research subjects. This questionnaire is used to assess physical activity on a 3-month, 6-month or 12-month basis. • Bioelectrical Impedance Analysis (BIA) • The bioelectrical impedance analysis (BIA) is another method used to estimate total body fat percentage. It is a simple, non-invasive procedure that utilizes electrodes attached to the subject’s right hand and foot. A mild, undetectable electrical current is then passed between these two areas and the resistance and reactance to that current are measured. These values can then be used to estimate various elements of body composition.

18. What the Bionutritionists need from the Study Staff • Timely pick-up of completed bionutrition data forms – including activity questionnaires, calcium questionnaires, completed food records, calorie counts etc. • Pick-up in the Bionutrition office (room 1303) no later than one week after the study visit unless other arrangements have been made with the study team.

19. Bionutrition Data Form

20. Contact Us ! • Names: Leigh Keating, MS, RD, LDN Jane Hubbard, MS, RD, LDN Tara Minaker, RD, LDN • Location: White 1303 • Hours: Monday through Thursday 7am – 5:30pm Friday 7 am – 4:00pm Saturday from 7am – 3:30pm (varies) • Phone: (617) 726-2540 • Email: Kkeating@partners.org Jhubbard1@partners.org Tminaker@partners.org

21. Bionutrition Manager Contact Information • Contact Information • Ellen J. Anderson, MS, RD, LDN • (617) 724-2830 • Beeper 36640 • eanderson1@partners.org www.mgh.harvard.edu/GCRC

22. Go Back to GCRC Orientation