Perkins Timeline

20 Years of Excellence • Celebrate the Past – Embrace the Future 1980’s • Encouraged vegetable vs. animal fats, not knowing the hazards of trans fat • Encouraged MI patients to avoid caffeine and gassy foods • BMI became standard vs. height/weight tables • Initial pre-filled enteral feeding systems • Introduction of disease-specific enteral formulas (Pulmocare) • First Fiber containing enteral formula

1989 • First JPEN released • Alimentum introduced as first hydrolyzed protein formula • Disease-Specific enteral formula for Diabetic management introduced

1995-1997

1990’s

• Through the MMC tube feeding clinical indicator process, patients received greater than 85% goal nutrient delivery sooner while also decreasing tube feeding waste

• First use of 3 in 1 TPN at Maine Medical Center • Tube feeds ordered as ½, ¾ strength

1990 • Tenth Edition of the RDA’s released • Introduction of Immuneenhanced Enteral Formulas • 1990 article on TPN described combining enteral feeding at 10-20 ml per hour to maintain gut integrity with TPN during acute illness is an exciting possibility

1991 • First publication of MMC’s Nutrition Support Handbook

1992 • First Food Guide Pyramid released • Nutrition Symposium topic - Early Enteral Feeding: Pros and Cons • Articles advocating use of carbonated beverages and meat tenderizers to unclog feeding tubes

1993

1994

• The American Academy of Family Physicians, in partnership with the ADA and the National Council on Aging, released the Nutrition Screening Initiative

• Nutrition Labeling and Education Act enacted requiring nutrition food labels

1995 • National Kidney foundation launched the Dialysis Outcomes Quality Initiatives (DOQI)

1996

1997 • Dietary Reference Intakes reported for calcium, phosphorus, magnesium, vitamin D and fluoride

1998 • NIH lowered the threshold of obesity based on BMI from 27.8 to 25 to match international guidelines, adding 30 million Americans to overweight category • Dietary Reference Intakes reported for B vitamins and folate

1999 • DOQI developed into the Kidney Disease Outcome Quality Initiative (KDOQI) in which target for practice included all phases of CKD

2000 • We survived Y2K! • Started hearing about Functional Foods, shifting from what to avoid to what to eat for health

2001 • First “Careminder” computer documentation of nutrition assessments • Initiation of closed system for tube feedings at MMC

2002 2002- 2004 2003

• Moratorium on use of Food dye in tube feedings

• Enterobacter sakazakii infection associated with use of powdered infant enteral formula. • Nutrition Services wins 1st Place in the Dr Cox Performance Improvement Fair • 6/1/02 – First RD/DTRs to use the Professional Development Portfolio Process • Breastfeeding rates reached an all time high in the U.S. with 70% of mothers initiating breastfeeding in the hospital • FDA approved DHA and ARA in U.S. formulas with the first formula, Enfamil Lipil, released by Mead Johnson

• Rising interest in local, fresh, whole, organic foods • Dietary Reference Intakes reported for sodium, potassium, chloride and sulfate • Nutrition Services at MMC wins Ivy Award

• Nutrition Symposium presented: Type 2 Diabetes in Children – A Growing Epidemic • National Cholesterol Education Program, Adult Treatment Panel III Guidelines released

2005 • Updated Dietary Guidelines released – “My Pyramid”

2006

2007

2008

• October 2006 – ADA House of Delegates voted to implement the Nutrition Care Process Model across the profession

• ADA Dietetic Practice Groups celebrated their 30th anniversary with increased membership from 42% in 2001 to 47% in 2007. 31,400 members enrolled in one or more of 29 Dietetic Practice Groups.

• New Choose Your Food Exchange Lists for Diabetics released:

• Nutrition Symposium presented: Bariatric Surgery – Lab Band vs Gastric Bypass. Also reviewed increased incidence and treatment of C.Diff.

~ Bagel (4 oz) now 4 servings ~ Added amaranth and jicama ~ Expanded glossary including A1C, glycemic load • Implementation of the ADA Nutrition Manual • Changed from traditional ADA Diabetic diets to carbohydrate gram diets

2009 • Implementation of new electronic Sunrise Clinical Manger documentation • For the first time in ADA’s 92 year history, membership surpassed 70,000

20 Years of Excellence • Celebrate the Past – Embrace the Future 1980’s • Encouraged vegetable vs. animal fats, not knowing the hazards of trans fat • Encouraged MI patients to avoid caffeine and gassy foods • BMI became standard vs. height/weight tables • Initial pre-filled enteral feeding systems • Introduction of disease-specific enteral formulas (Pulmocare) • First Fiber containing enteral formula

1989 • First JPEN released • Alimentum introduced as first hydrolyzed protein formula • Disease-Specific enteral formula for Diabetic management introduced

1995-1997

1990’s

• Through the MMC tube feeding clinical indicator process, patients received greater than 85% goal nutrient delivery sooner while also decreasing tube feeding waste

• First use of 3 in 1 TPN at Maine Medical Center • Tube feeds ordered as ½, ¾ strength

1990 • Tenth Edition of the RDA’s released • Introduction of Immuneenhanced Enteral Formulas • 1990 article on TPN described combining enteral feeding at 10-20 ml per hour to maintain gut integrity with TPN during acute illness is an exciting possibility

1991 • First publication of MMC’s Nutrition Support Handbook

1992 • First Food Guide Pyramid released • Nutrition Symposium topic - Early Enteral Feeding: Pros and Cons • Articles advocating use of carbonated beverages and meat tenderizers to unclog feeding tubes

1993

1994

• The American Academy of Family Physicians, in partnership with the ADA and the National Council on Aging, released the Nutrition Screening Initiative

• Nutrition Labeling and Education Act enacted requiring nutrition food labels

1995 • National Kidney foundation launched the Dialysis Outcomes Quality Initiatives (DOQI)

1996

1997 • Dietary Reference Intakes reported for calcium, phosphorus, magnesium, vitamin D and fluoride

1998 • NIH lowered the threshold of obesity based on BMI from 27.8 to 25 to match international guidelines, adding 30 million Americans to overweight category • Dietary Reference Intakes reported for B vitamins and folate

1999 • DOQI developed into the Kidney Disease Outcome Quality Initiative (KDOQI) in which target for practice included all phases of CKD

2000 • We survived Y2K! • Started hearing about Functional Foods, shifting from what to avoid to what to eat for health

2001 • First “Careminder” computer documentation of nutrition assessments • Initiation of closed system for tube feedings at MMC

2002 2002- 2004 2003

• Moratorium on use of Food dye in tube feedings

• Enterobacter sakazakii infection associated with use of powdered infant enteral formula. • Nutrition Services wins 1st Place in the Dr Cox Performance Improvement Fair • 6/1/02 – First RD/DTRs to use the Professional Development Portfolio Process • Breastfeeding rates reached an all time high in the U.S. with 70% of mothers initiating breastfeeding in the hospital • FDA approved DHA and ARA in U.S. formulas with the first formula, Enfamil Lipil, released by Mead Johnson

• Rising interest in local, fresh, whole, organic foods • Dietary Reference Intakes reported for sodium, potassium, chloride and sulfate • Nutrition Services at MMC wins Ivy Award

• Nutrition Symposium presented: Type 2 Diabetes in Children – A Growing Epidemic • National Cholesterol Education Program, Adult Treatment Panel III Guidelines released

2005 • Updated Dietary Guidelines released – “My Pyramid”

2006

2007

2008

• October 2006 – ADA House of Delegates voted to implement the Nutrition Care Process Model across the profession

• ADA Dietetic Practice Groups celebrated their 30th anniversary with increased membership from 42% in 2001 to 47% in 2007. 31,400 members enrolled in one or more of 29 Dietetic Practice Groups.

• New Choose Your Food Exchange Lists for Diabetics released:

• Nutrition Symposium presented: Bariatric Surgery – Lab Band vs Gastric Bypass. Also reviewed increased incidence and treatment of C.Diff.

~ Bagel (4 oz) now 4 servings ~ Added amaranth and jicama ~ Expanded glossary including A1C, glycemic load • Implementation of the ADA Nutrition Manual • Changed from traditional ADA Diabetic diets to carbohydrate gram diets

2009 • Implementation of new electronic Sunrise Clinical Manger documentation • For the first time in ADA’s 92 year history, membership surpassed 70,000