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The Nuer Nutrition Education Program: breaking down cultural barriers.

Very little is known about the Nuer culture, partly because of its widely misunderstood language and because of the mixture of its people with the other tribes in Africa, according to Evans-Pritchard). However, it is known that the Nuer women's roles in the family seem to be centered around cooking duties. In the Nuer culture, no work is considered degrading, and the women know and accept their domestic duties. During the summer of 1996, a pilot project was conducted as an attempt to help Nuer refugee women of Des Moines, Iowa, incorporate nutritional concepts and American food preparation techniques into their existing methods of food preparation. The barriers faced involved the Nuer women's unfamiliarity with American foods and household items and their inability to read and understand English. Cultural issues and barriers were overcome when the health educator was willing to take the time to gain the trust and respect of the Nuer people. Structured interviews indicated an increase in knowledge of American foods and cooking skills. This education program in no way meant to replace traditional Nuer cooking methods; rather, it acted as a way to adjust to life in the United States.

Acculturation↗

Effectiveness of school programs in preventing childhood obesity: a multilevel comparison.

OBJECTIVES: In light of the alarming increase in childhood obesity and lack of evidence for the effectiveness of school programs, we studied the effects of school programs in regard to preventing excess body weight. METHODS: In 2003, we surveyed 5200 grade 5 students along with their parents and school principals. We measured height and weight, assessed dietary intake, and collected information on physical and sedentary activities. We compared excess body weight, diet, and physical activity across schools with and without nutrition programs using multilevel regression methods while adjusting for gender and socioeconomic characteristics of parents and residential neighborhoods. RESULTS: Students from schools participating in a coordinated program that incorporated recommendations for school-based healthy eating programs exhibited significantly lower rates of overweight and obesity, had healthier diets, and reported more physical activities than students from schools without nutrition programs. CONCLUSIONS: Our finding that school programs are effective in preventing childhood obesity supports the need for broader implementation of successful programs, which will reduce childhood obesity and, in the longer term, comorbid conditions and health care spending.

Body Height↗

Feeding Infants and Toddlers Study: characteristics and usual nutrient intake of Hispanic and non-Hispanic infants and toddlers.

OBJECTIVE: To compare demographic and maternal characteristics and usual nutrient intakes of Hispanic and non-Hispanic infants and toddlers 4 to 24 months of age in the United States. DESIGN: We conducted three interviews by telephone to collect information on sociodemographic and maternal characteristics, feeding practices, and dietary intake in the 2002 Feeding Infants and Toddlers Study. We collected 24-hour dietary recalls, including a second day's intake on a subsample, using the Nutrition Data System for Research. We used the Personal Computer version of the Software for Intake Distribution Estimation to estimate usual nutrient intake and nutrient adequacy and excess for three age subgroups-infants 4-5 months, infants 6-11 months, and toddlers 12-24 months-and Hispanic or non-Hispanic ethnicity. SUBJECTS: A national sample of 3,022 infants and toddlers age 4-24 months, including 371 Hispanic and 2,637 non-Hispanic subjects. STATISTICAL ANALYSIS: We compared means, percentile distributions, and percentages by age/Hispanic ethnicity subgroup, and applied the Dietary Reference Intakes to assess nutrient intakes. RESULTS: Mothers of Hispanic infants and toddlers were younger, less likely to be married, and had lower education levels than mothers of non-Hispanic infants and toddlers (P<.01). Hispanic infants and toddlers had significantly higher rates of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children than non-Hispanic infants and toddlers (42% to 23%) and were more likely to reside in urban areas and have lower annual household income levels (P<.01). There were no significant differences in usual energy intake between Hispanic and non-Hispanic infants and toddlers, and mean usual energy intake exceeded the mean estimated energy requirement for all age/ethnicity subgroups. Hispanic toddlers consumed a significantly higher proportion of energy from carbohydrate (56% to 53%, P<.01) and a significantly lower percentage of energy from fat (31% to 33%, P<.01) than non-Hispanics. Comparing usual mean intakes, Hispanic infants age 6 to 11 months had a significantly lower intake of calcium than non-Hispanics (means of 574 mg and 626 mg per day, respectively, P<.05) and a significantly higher intake of sodium compared with non-Hispanics of the same age (means of 647 mg to 476 mg per day, P<.01). For infants, mean usual intakes were adequate for all nutrients. For toddlers, the prevalence of nutrient inadequacy was low (<1%) with the exception of vitamin E, which was inadequate for 39% of Hispanic toddlers and 50% of non-Hispanic toddlers. For nutrients with defined Tolerable Upper Intake Levels, more than one third to almost half of toddlers exceeded the Tolerable Upper Intake Levels for vitamin A and zinc, and more than half (53% and 58% for Hispanics and non-Hispanic toddlers, respectively) exceeded the Tolerable Upper Intake Level for sodium. Usual mean intakes of vitamins A, C, and E and folate, potassium, and fiber were significantly higher among Hispanic toddlers compared with non-Hispanic toddlers. CONCLUSIONS: The Feeding Infants and Toddlers Study data provide information that is useful to practitioners, Special Supplemental Nutrition Program for Women, Infants, and Children program staff, and parents for delivering nutrition education messages that are consistent with dietary guidance for infants and toddlers as well as compatible with cultural preferences.

Adult↗

Progress toward a national food policy-its implications.

Over the last several years, the Senate Select Committee on Nutrition and Human Needs has conducted hearings in an effort to obtain experts' recommendations, prior to proposing legislation to establish a comprehensive national nutrition plan. The framework for such a plan, as developed by the Committee, is presented here. A "nutritional state of the union" report-to include a formal assessment of existing conditions plus specific goals-would be made annually. To insure accountability, a Federal Nutrition Office, headed by a Cabinet-level official, would be responsible for coordination and monitoring all nutrition programs in all governmental agencies and would have the right to review (but not veto) proposals before an agency could issue them officially. In addition, there would be a National Nutrition Center in the Department of Health, Education, and Welfare, charged with day-to-day administration of expanded nutrition program. This Center would operate at the Sub-Cabinet level.

Agriculture↗

Nature, nurture, nutrition: interdisciplinary programs to address the prevention of malnutrition and dehydration.

Malnutrition and dehydration are common problems in nursing home patients. One explanation for this may be the large number of patients requiring feeding assistance. The Dysphagia Team at the Department of Veterans Affairs Medical Center in Miami, Florida served as the primary source in the expansion of a nutritionally supportive environment to assist in the prevention of malnutrition and dehydration in patients with feeding/swallowing disorders. "Silver Spoons," a program in which volunteers provide supervised feeding, "Happy Hour," a time each day during which an atmosphere is provided that encourages socialization and hydration, and "Second Seating," during which lunch is provided for patients who require modification of eating style, food texture, or timing are described. Analysis of the program's outcomes show it to be timely, pleasing to patients, and cost-effective.

Aged↗

Black non-Hispanic mothers' perceptions about the promotion of infant-feeding methods by nurses and physicians.

OBJECTIVE: To describe reports of low-income Black non-Hispanic women about the promotion of infant-feeding methods by nurses and physicians. DESIGN: Ethnographic research conducted over 18 months with interviewing and participant observation of informants. SETTING: The study took place in a Special Supplemental Nutrition Program for Women, Infants, and Children clinic and neighborhood in the New York metropolitan area. PARTICIPANTS: 130 Black non-Hispanic mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children were general informants. From this group, 11 primiparous key informants were selected for close follow-up during pregnancy and the 1st postpartum year. MAIN OUTCOME MEASURES: Audiotaped interviews and field notes were analyzed for mothers' descriptions of infant-feeding education and support from nurses and physicians. FINDINGS: The informants reported limited breastfeeding education and support during pregnancy, childbirth stay in neonatal intensive care unit, postpartum, and recovery in the community. They also expressed trust/distrust concerns and varying degrees of anxiety about the ways they were treated by nurses and physicians. CONCLUSIONS: To decrease disparities in breastfeeding, this research suggests that health care professionals should focus their efforts on the development of trusting relationships and continuity of care along with clear, consistent breastfeeding education and support.

Adult↗

Determinants of neonatal mortality rates in the U.S. A reduced form model.

The aim of this paper is to contribute to an understanding of the determinants of differences in race-specific neonatal mortality rates among large counties of the U.S. in 1977. After estimating cross-sectional regressions, we apply their coefficients to national trends in the exogenous variables to 'explain' the rapid decline in neonatal mortality since 1964. The regressions and the extrapolations point to the importance of abortion availability, neonatal intensive care availability, females' schooling levels, Medicaid, and to a lesser extent Bureau of Community Health Services projects, poverty, maternal nutrition programs and organized family planning in trends in black neonatal mortality between 1964 and 1977. They also underscore the importance of schooling, neonatal intensive care, poverty, Medicaid, maternal nutrition programs, abortion, and organized family planning clinics in trends in white neonatal mortality in those years.

Black or African American↗

Maternal low-protein diet in rat pregnancy programs blood pressure through sex-specific mechanisms.

Animal models support human epidemiological studies in demonstrating a relationship between impaired fetal growth and risk of adult hypertension. Undernutrition during pregnancy exerts programming effects on the developing kidney, and modulation of angiotensin receptor (ATR) expression has been observed persisting into adult life. Fetal overexposure to glucocorticoids is thought to be central to the nutritional programming of blood pressure and may act through an interaction with ATR expression. Pregnant female Wistar rats were fed a control (n = 6) or a maternal low-protein diet (MLP; n = 17) throughout pregnancy. The glucocorticoid dependency of MLP effects was tested using metyrapone, an inhibitor of corticosterone synthesis. MLP-fed rats were injected twice daily with metyrapone, metyrapone plus corticosterone, or vehicle over days 1-14 of pregnancy. At delivery, all animals were fed standard laboratory chow. MLP-exposed offspring 4 wk of age exhibited increased systolic blood pressure compared with controls (P < 0.05), which proved to be glucocorticoid dependent in males only. AT(1)R mRNA expression was independent of in utero dietary treatment. AT(2)R mRNA expression was downregulated in MLP-exposed females only (P < 0.05) and in a glucocorticoid-independent manner. Male offspring exhibited glucocorticoid-dependent hypertension with no modulation of renal ATR mRNA expression. In contrast, female offspring exhibited glucocorticoid-independent hypertension associated with reduced expression of renal AT(2)R mRNA. These data do not support the hypothesis that an interaction between glucocorticoid and ATR mRNA expression underlies the nutritional programming of blood pressure but instead suggest two independent mechanisms acting in a sex-specific manner.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗