Can nutrition counselling be more behavioural? Lessons learned from dietary management of cystic fibrosis
Can nutrition counselling be more behavioural? Lessons learned from dietary management of cystic fibrosis
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DOI：
10.1079/pns2003294
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发表时间：
2003-11-01
影响因子：
7
通讯作者：
Stark, LJ
中科院分区：
文献类型：
--
作者：
Stark, LJ
囊性纤维化（CF）是一种导致能量失衡的遗传性疾病。营养不良在 CF 儿童中很常见，并与不良的健康结果相关。为了确保最佳的生长和营养，建议患有 CF 的儿童摄入建议每日摄入量 (RDA) 的 120-150% 的能量，但大多数研究表明，他们通常只能达到 RDA 的 100%。虽然生物因素显然会导致饮食依从性差，但最近的研究记录了饮食依从性的行为和环境障碍，包括进餐时的亲子互动。虽然不是“异常”，但当孩子做出与进食不相容的行为（拒绝进食、说话、离开饭菜）时，父母的行为，例如以哄骗、命令和喂食的形式更加关注孩子，可能会强化孩子的不进食行为。因此，尽管有必要，但单独的饮食咨询通常是不够的，因为无法具体解决饮食治疗的这些行为和环境障碍。研究发现，针对营养教育和行为管理的行为干预可以有效地使 CF 儿童在 9 周内平均增加能量摄入 4200 kJ（1000 kcal）/天，体重增加 1-48 kg。这种干预利用自我监控、目标设定和塑造来构建治疗的实施。它还教导家长利用儿童行为管理技术来激励孩子增加能量摄入。这些行为策略包括差异性关注（表扬和忽视）、应急管理和行为契约。建议将这些技术应用于饮食咨询。
Cystic fibrosis (CF) is a genetically-inherited disorder that results in energy imbalance. Undernutrition is common in children with CF and associated with poor health outcomes. To ensure optimal growth and nutrition, children with CF are recommended to consume 120-150% of the recommended daily allowance (RDA) for energy, but most studies show they typically are only able to achieve 100% of the RDA. While biological factors clearly contribute to poor dietary adherence, recent studies have documented behavioural and environmental barriers to adherence that includes parent-child interaction at mealtimes. While not 'abnormal', parent behaviours such as paying increased attention to the child in the form of coaxing, commanding and feeding when the child is engaged in behaviours incompatible with eating (food refusal, talking, leaving the meal) may serve to reinforce these child non-eating behaviours. Thus, dietary counselling alone, albeit necessary, is typically insufficient because of failure to specifically address these behavioural and environmental barriers to dietary treatment. Behavioural intervention that targets both nutrition education and behavioural management has been found to be effective in achieving an average increased energy intake of 4200 kJ (1000 kcal)/d and weight gain of 1-48 kg over 9 weeks in children with CF. This intervention utilizes self-monitoring, goal setting and shaping to structure the delivery of treatment. It also teaches parents to utilize child behaviour-management techniques to motivate children to increase their energy intake. These behavioural strategies include differential attention (praising and ignoring), contingency management and behavioural contracting. The potential application of these techniques to dietary counselling is suggested.