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

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

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

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

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.”

recruitment inclusion criteriaexclusion 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

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

results requirements met energy (kcal) CHO vitamins ◦ K (female) ◦ C ◦ thiamine (female) ◦ niacin ◦ B 6 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 servingssubjects’ intake grains6 – ± 0.5 ( ) vegetables & fruit7 – ± 0.5 ( ) milk & alternatives2 – ± 0.4 ( ) meat & alternatives2 – 31.2 ± 0.3 (0 - 3) number of recommended servings from CFG food groups compared to subjects’ intake

nutrient recommended serum levelssubjects' serum levels albumin g/L 40.1 ± 1.1 ( ) ferritin μ g/L 97.6 ± 27.9 ( ) RBC folate > 372 nmol/L ± ( ) vitamin B12 > 131 pmol/L ± 39.2 ( ) vitamin D > pmol/L53.3 ± 10.3 ( ) accepted serum nutrient ranges compared to subjects’ serum levels

HFIAS category: ◦ 1  1 subject ◦ 2  1 subject ◦ 3  2 subjects ◦ 4  8 subjects 67% reported severe food insecurity

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?

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

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

summary conclusionsrecommendations 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

questions?