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PubMed2005

Community-based nutrition education for improving infant growth in rural Karnataka.

OBJECTIVE: To evaluate a nutrition education intervention designed to improve infant growth and feeding practices. DESIGN: An intervention study using monthly nutrition education delivered by locally trained counsellors targeted at caregivers of infants aged 5-11 months. Comparison of outcomes for 2 groups--one non-intervention group of infants enrolled in 1997 that did not receive the intervention in the first year of life, and an intervention group of infants enrolled 1998-1999 that received the nutrition education. SETTING: 11 randomly selected and 2 purposively selected villages of south Karnataka. SUBJECTS: 138 Infants (n = 69 intervention) aged 5-11 months. METHODS: Families were administered a monthly questionnaire on feeding and child care behavior, and study infants were weighed at this time, using the SECA solar scales, developed for UNICEF. Logistic regression was used to examine differences between intervention and non-intervention infants in infant feeding behavior outcomes. RESULTS: Statistically significant improvement was found in weight velocity for female infants in the intervention group. These infants were also more likely to exhibit at least four positive feeding behaviors--intervention infants had a higher mean daily feeding frequency (more likely to be fed solids at least four times a day (OR = 4.35, 95% CI = 1.96, 10.00), higher dietary diversity (more likely to receive a more diverse diet OR = 3.23, 95% CI = 1.28, 7.69), and were more likely to be fed foods suggested by the counsellors such as bananas (OR = 10.00, 95% = 2.78, 33.3) compared to non-intervention infants. CONCLUSION: Nutrition education and counselling was significantly associated with increased weight velocity among girls and improved feeding behavior among both boys and girls. These results provide further evidence that community-based nutrition programs that emphasise appropriate feeding and care behavior can be used to prevent and address early childhood malnutrition in poor households.

Adult↗
PubMed1987

The Fifth World Food Survey: an assessment of food supplies and malnutrition.

The methodology and findings of the United Nations Food and Agriculture Organization's Fifth World Food Survey are reviewed. Data compiled from national food balance sheets indicate that per capita energy supplies increased by 14% during the past two decades. The number of undernourished is estimated for the periods 1969 to 1971 and 1979 to 1981 on the basis of a distribution of population food intakes and two alternative estimates of minimal energy requirements. The survey findings indicate that the proportion of undernourished in the developing market economies decreased, although an estimated 335 million to 494 million people fall in this category. In the least developed countries, the proportion of undernourished increased during this period. Elimination of poverty, the fundamental cause of malnutrition, through increased economic and agricultural development, is regarded as the only long-term solution to malnutrition. Short-term solutions are also needed to address interim needs and the diverse environmental, social, and cultural factors implicated in the causation of malnutrition. Short-term solutions include nutrition programs, complementary health measures, food subsidies, population programs, and programs aimed at improving the status of women. Projected future food needs in developing countries also indicate the need for increased international food trade and expanded foreign aid.

Developing Countries↗
PubMed2001

Nutritional challenges of infants with cystic fibrosis.

Nutrition plays an essential role in the management of cystic fibrosis (CF), particularly in infants with their high energy requirement due to rapid growth. Most infants are already malnourished at the time of clinical diagnosis due to an energy imbalance with increased losses and needs not compensated by energy intake. Even in very young asymptomatic CF patients diagnosed by neonatal screening programs, nutritional deficits can be detected in a high proportion of infants, since about half of all CF patients have evidence of pancreatic insufficiency at the time of birth. This review provides recommendations for assessment of the nutritional status at diagnosis and nutritional management including supplementation with pancreatic enzymes during the first year of life.

Cystic Fibrosis↗
PubMedDate not supplied

[Diet therapy of severe obesity].

In the last decades there has been a dramatic increase of obese subjects in many countries with the subsequent increase of health related problems, such as diabetes, hypertension, cardiovascular diseases. Even though several differential approaches, as media communication, guidelines formulation, have been performed in many different countries to solve this burden global health problem, no satisfactory results have been obtained. Personalized nutritional programs have been selected by obese subjects. Thus the correct approach would be to prescribe a caloric restricted diet in order to achieve long term weight loss in overweight or obese people. The aim in planning weight-reduction diets is that total food intake should meet recommended dietary allowance/adequate intake levels with the maintenance of the equilibrium among nutrients. If the nutritional approach fails or it is not sufficient to obtain significant weight loss, bariatric surgical intervention has been developed for the treatment of morbid-obese patients or severe obese patients with comorbidities as recommended by the American Society for Bariatric Surgery (A.S.B.S.) guidelines.

Bariatric Surgery↗
PubMed2006

Maternal nutrient restriction alters renal development and blood pressure regulation of the offspring.

Studies have shown that the risk of hypertension in adulthood can be affected by the in utero environment. It is established that hypertension is linked to compromised kidney function and that factors affecting organogenesis can increase the risk of later disease. Prostaglandins (PG) and growth factors are known to play an important role in regulating kidney function and renal organogenesis. The extent, however, to which global energy restriction (where all nutrients are reduced) of the mother can programme later blood pressure control or renal PG and growth factor status is unknown. A study is described that aimed to examine the long-term effects of maternal nutrient restriction (NR) and elucidate their relationship with compromised kidney development. First, it was necessary to establish animal models. A sheep model of 50% NR during specific stages of gestation was used to investigate fetal renal development, whilst a rat model of 50% NR throughout pregnancy was used to investigate postnatal kidney development and adult functioning. Molecular analysis has shown that expression of the growth hormone-insulin-like growth factor (GH-IGF) axis is affected by NR in the fetal sheep kidneys, and that changes are dependent on the timing of NR and whether the fetus is a singleton or a twin. Analysis of the kidneys from the rat model has shown nutritional differences in the expression of PG receptors and the enzymes responsible for PG synthesis and degradation that persist into adulthood. In conclusion, NR does affect the GH-IGF and PG axes, and these changes may be important in the nutritional programming of renal functioning and adult blood pressure control.

Animals↗
PubMed2006

Meeting the dietary reference intakes for fiber: sociodemographic characteristics of preschoolers with high fiber intakes.

To better understand the public health impact of the National Academy of Sciences' Dietary Reference Intakes (DRIs) for fiber in preschoolers, I analyzed data from the United States Department of Agriculture Continuing Survey of Food Intake in Individuals for 5437 preschoolers and examined sociodemographic predictors of meeting the DRIs. Overall, only 12% of the children met the DRIs. Older children (age 4 and 5 years) were less likely than younger children, girls were less likely than boys, and children from medium-income families (those earning 186% to 350% of the poverty guidelines, with poverty set at 100%) were least likely to meet the DRIs. Low-income children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children were twice as likely as nonparticipants to meet the DRIs. The public should be educated about the importance of increasing fiber density in the diet.

Age Factors↗
PubMed2004

The eHealth Behavior Management Model: a stage-based approach to behavior change and management.

Although the Internet has become an important avenue for disseminating health information, theory-driven strategies for aiding individuals in changing or managing health behaviors are lacking. The eHealth Behavior Management Model combines the Transtheoretical Model, the behavioral intent aspect of the Theory of Planned Behavior, and persuasive communication to assist individuals in negotiating the Web toward stage-specific information. It is here - at the point of stage-specific information - that behavioral intent in moving toward more active stages of change occurs. The eHealth Behavior Management Model is applied in three demonstration projects that focus on behavior management issues: parent-child nutrition education among participants in the U.S. Department of Agriculture Special Supplemental Nutrition Program for Women, Infants and Children; asthma management among university staff and students; and human immunodeficiency virus prevention among South African women. Preliminary results have found the eHealth Behavior Management Model to be promising as a model for Internet-based behavior change programming. Further application and evaluation among other behavior and disease management issues are needed.

Adult↗
PubMed1999

Identifying target groups for a potential vaccination program during a hepatitis A communitywide outbreak.

OBJECTIVES: This study sought to identify groups for targeted vaccination during a communitywide hepatitis A outbreak in 1996. METHODS: Residents of the Sioux City, Iowa, metropolitan area reported with hepatitis A between September 1995 and August 1996 were sampled and compared with population-based controls. RESULTS: In comparison with 51 controls, the 40 case patients were more likely to inject methamphetamine, to attend emergency rooms more often than other health care facilities, and to have a family member who used the Special Supplemental Nutrition Program for Women, Infants, and Children. CONCLUSIONS: Groups at increased risk of hepatitis A can be identified that might be [corrected] accessed for vaccination during communitywide outbreaks.

Adult↗
PubMedDate not supplied

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India.

INTRODUCTION: In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children's nutritional status in rural south India. METHODS: A case-controlled study was conducted in a rural area in Tamil Nadu, India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital's list of young children. A case was defined as a mother of a severely malnourished child under four years of age. Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. A control had a well-nourished child and was matched by the location and the age of the child. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition. RESULTS: Poor nutritional status was associated with socioeconomic variables such as sex of the child and father's occupation. Female gender (OR = 3.44, p = .02) and father's occupation as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition. The two groups showed a significant difference in nutrition-related knowledge of mild mixed malnutrition (OR = 2.62, p = .05). No significant difference was apparent in health-care-seeking attitudes. Based on their traditional beliefs, the mothers did not believe that medical care was an appropriate intervention for childhood illnesses such as malnutrition or measles. DISCUSSION: The results suggested that the gender of the child and socioeconomic factors were stronger risk factors for malnutrition than health-care availability and health-care-seeking attitudes. The father's occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.

Adolescent↗
PubMed2006

Survey of herbal use by Kansas and Wisconsin WIC participants reveals moderate, appropriate use and identifies herbal education needs.

OBJECTIVE: To examine herbal use by a sample of low-income, nutritionally vulnerable children. DESIGN: Caregivers completed a survey of child and caregiver herbal usage practices. SUBJECTS/SETTING: A convenience sample of 2,562 caregivers to children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Kansas and Wisconsin who were attending a WIC clinic was selected. WIC project selection was random, with stratification for geographic and ethnic representation. STATISTICAL ANALYSES PERFORMED: Herbal usage profiles were described with measures of central tendency. Groups were compared with a two-tailed independent t test and chi2 for continuous and categorical variables, respectively. RESULTS: Child herbal use was reported on 917 surveys, representing 1,363 children ranging in age from 1 week to 17.5 years; 820 were younger than age 5 years. Herb use was greater among Latino children (48.4% vs 31.4%) and caregivers (43.4% vs 37.2%). Caregivers had a mean age of 27.8+/-8.32 years and 38.8% (n=994) denoted using herbs. Herbs most commonly used by children were aloe vera, chamomile, garlic, peppermint, lavender, cranberry, ginger, echinacea, and lemon. Reasons for herbal use paralleled recommendations. Family (78.9%) and friends (32.9%) were predominant information sources. Herbs with safety issues, such as St John's wort, dong quai, and kava were used. Herbal use characteristics did not differ between states, but were unique for Latino clients. CONCLUSIONS: Herbal use by WIC children is mostly congruent with known indications; however, practices with potential to harm urge herbal education in WIC clinics, especially for Latinos.

Adolescent↗
PubMed1999

Strategies to sustain success in childhood immunizations. The National Vaccine Advisory Committee.

OBJECTIVE: Following an outbreak of measles in 1989-1991, a blueprint for change was developed to improve immunization coverage by addressing deficiencies in the immunization delivery system. A review was undertaken by the National Vaccine Advisory Committee (NVAC) to assess progress in improving immunization coverage, decreasing disease incidence, and developing an immunization delivery system to serve children in the United States. Based on this review, strategies were recommended to sustain success in immunization coverage. PARTICIPANTS: A Subcommittee on Immunization Coverage was appointed by the chairman of the NVAC in 1995 and included representatives from federal agencies, professional organizations, vaccine manufacturers, state and regional health departments, and academic centers. EVIDENCE: Presentations on immunization programs, strategies, and financing were made to the subcommittee by representatives from federal, state, and local agencies; professional organizations; insurers; businesses; and public and private health care providers. Evidence from the published literature also was reviewed. CONSENSUS PROCESS: After review and discussion of evidence presented, conclusions and recommendations were crafted and endorsed by members of the subcommittee. The subcommittee's report was submitted to the NVAC for review, comment, and approval. CONCLUSIONS: Although incidence rates of traditional vaccine-preventable diseases are at all-time low levels and corresponding vaccination coverage rates are at all-time high levels, a system to ensure timely vaccination of the 11000 US infants born each day that also incorporates newly recommended vaccines is incomplete. Key barriers include lack of financing of vaccination in many insurance programs and the lack of implementation of evidence-based interventions to raise coverage levels. The NVAC makes 15 recommendations to achieve a sustainable childhood immunization delivery system organized around (1) vaccination financing to ensure full insurance coverage of recommended vaccines and to support the Vaccines for Children program; (2) provider practices to ensure the implementation of recall/reminder systems and office-based assessment of coverage levels; (3) information systems for monitoring disease, vaccination coverage, and performance on immunization delivery; and (4) support for communities and families to ensure that the public is aware of the importance of vaccination, that resources are focused to help underserved children, that immunization linkages with WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) are enhanced, and that citizen coalitions can advocate improvements in the immunization delivery system.

Child↗
PubMed2002

Preventing nutritional disorders in athletes: focus on the basics.

The prevention of nutritional disorders in athletes is often a controversial topic. The answer centers on the practitioners ability to assess each participant's individual needs, ensuring that basic nutrient requirements are met. The cornerstone to any athlete's nutritional program is to ensure an adequate energy intake correctly proportioned with macronutrients. Inherent to this goal is the understanding that exposure to chronic stress alters energy depots: musculoskeletal structure and immune/inflammatory responses that either facilitate or hinder training based on recovery. Essential to the athlete's health is the understanding that each is a unique individual who will never fit neatly into a predefined, cookbook approach to nutrition. Failure to meet these objectives will only impair recovery. Although quality training and adequate rest is important to training, so too is adequate energy balance. This article focuses on better understanding the benefits of adequate energy balance, further enhanced by a better understanding of macronutrient use.

Dietary Carbohydrates↗
PubMed1998

Exploratory analysis of factors associated with teens' repeated childbearing.

This study was designed to explore the factors regarding unique determinants of repeat childbearing among teens. The influence that key people have on subsequent teen childbearing is examined. Data for this research were gathered in focus groups with teen mothers and parents of teen mothers who access the Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Georgia. Based on the results, repeated childbearing appears to occur within the context of poor parent-child relations, conflicting support for the roles teen mothers are expected to assume, limited social pressures for effective fathering, and limited access to social services for all family members. Pregnancy prevention efforts by agencies for teen mothers should coordinate services for the teen mother, her parent, and her partner.

Adolescent↗
PubMed2004

Healthy living in Nunavut: an on-line nutrition course for inuit communities in the Canadian arctic.

OBJECTIVES: It is recognized that empowerment of Indigenous Peoples through training and education is a priority. The objective was to design a course that would provide an innovative training approach to targeted workers in remote communities and enhance learning related to the Nunavut Food Guide, traditional food and nutrition, and diabetes prevention. STUDY DESIGN: A steering committee was established at the outset of the project with representation from McGill University and the Government of Nunavut (including nutritionists, community nurses and community health representatives (CHRs), as well as with members of the target audience. Course content and implementation, as well as recruitment of the target audience, were carried out with guidance from the steering committee. METHODS: An 8-week long course was developed for delivery in January - March, 2004. Learning activities included presentation of the course content through stories, online self-assessment quizzes, time-independent online discussions and telephone-based discussions. Invitations were extended to all prenatal nutrition program workers, CHRs, CHR students, home-care workers, Aboriginal Diabetes Initiative workers and public health nurses in Nunavut. RESULTS: Ninety-six health-care workers registered for Healthy Living in Nunavut, with 44 actively participating, 23 with less active participation and 29 who did not participate. CONCLUSIONS: Despite having to overcome numerous technological, linguistic and cultural barriers, approximately 40% of registrants actively participated in the online nutrition course. The internet may be a useful medium for delivery of information to target audiences in the North.

Arctic Regions↗
PubMed2006

[Impact of the guidelines on clinical practice of artificial nutrition in intensive care unit after cardiovascular and thoracic surgery].

OBJECTIVE: To analyze the impact of an artificial nutrition program in post-anaesthesia intensive care unit. STUDY DESIGN: Observational study. PATIENTS AND METHODS: Patients with length of stay greater than 8 days after cardiovascular and thoracic surgery: Group 1: 34 patients (4-month period in 2000); group 2: 15 patients (2-month period in 2001); group 3: 40 patients (4-month period in 2003). Between these 3 periods, informations of physicians and written protocol in order to improve their nutritional knowledge. After analysis of variance (P<0.05). Newman-Keuls tests to compare themselves each groups. RESULTS: Anthropometric, demographic and clinical parameters were similar in the 3 groups. Energic intakes were less than 80% of basal energetic expenditures in 33%, 33 and 22% of patient, respectively (NS). Caloric and nitrogen intakes were less than recommended, respectively 19+/-6 (mean+/-SD), 21+/-7 and 21+/-8 kcal/kg/24 h and 102+/-32, 111+/-31 and 92+/-40 mg/kg/24 h (NS). However enteral nutrition was administered in 49, 40 and 100% of patients respectively (P<0.001). The glucid/lipid ratio improved from 0.47 in group 1 up to 0.68 in group 3 (P<0.0001). Vitamins, oligoelements and clinical and biological monitoring of artificial nutrition improved (P<0.001). CONCLUSION: A clinical audit demonstrated an improvement in artificial nutrition parameters but no significant change in others.

Aged↗
PubMed2003

Ethiopian-born and native Israeli school children have different growth patterns.

OBJECTIVE: Nutrition status of preschool children in Azezo, North West Ethiopia, and Ethiopian-born and native Israeli children aged 7 to 11 y and 12 to 15 y was studied. The aim of the study was to determine the growth patterns of immigrant children after changes in their nutritional habits. METHODS: The Ethiopian-born and native school children were recruited from a caravan-dwelling site and a boarding school and from a town adjacent to the caravan site and a boarding school, respectively. RESULTS: Weight for age was lower than -2 standard deviations of the Z score in 40.5%, 55.6%, 31.9%, and 61% of children aged 1 to 24, 25 to 36, 37 to 48, and 49 to 60 mo, respectively. Similarly, 18.9%, 59.3%, 39.1%, and 19.5% of children aged 1 to 24, 25 to 36, 37 to 48, and 49 to 60 mo had a height for age lower than -2 standard deviations of the Z score. The Ethiopian-born boys aged 7 to 11 y had lower body weight (P < 0.03), mean arm muscle circumference, plasma transthyretin and magnesium (P < 0.0001), and higher triceps skinfold thickness (P < 0.01) compared with the controls. Similarly, the Ethiopian-born girls had lower body weight (P < 0.006), weight-to-height ratio (P < 0.02), mean arm muscle circumference and plasma transthyretin, calcium, and magnesium (P < 0.0001), and higher triceps skinfold thickness (P < 0.0001) than their Israeli counterparts. Weight, weight-to-height ratio, mean arm muscle circumference, plasma calcium and magnesium (P < 0.0001), and transthyretin (P < 0.01) were lower and triceps skinfold thickness (P < 0.0001) was higher in the Ethiopian-born boarding school children than in the native Israelis of the same age range. CONCLUSIONS: The Azezo study confirmed that malnutrition-induced developmental impairment in preschool children is a major problem in Ethiopia. It is a manifestation of a rural economic and educational poverty and cannot be eradicated by palliative short-term nutritional programs. Although ethnicity and prenatal and postnatal malnutrition may have contributed, an insufficiency or imbalance of vital nutrients appeared to be the determinant factor for the lower relative growth of the Ethiopian-born children. The children from Ethiopia may have a propensity to avoid certain foods because of digestive intolerance or early childhood dietary habituation. Parental financial constraint may have been a factor in the younger group. These findings have implications for nutrition and welfare policies for children emigrating from developing countries.

Adolescent↗
PubMed2004

Pakistan's maternal and child health policy: analysis, lessons and the way forward.

An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These translate into an infant mortality rate and maternal mortality ratio that should be unacceptable to any state. Disease states including communicable diseases and reproductive health (RH) problems, which are largely preventable account for over 50% of the disease burden. The analysis of Pakistan's maternal and child health (MCH) and family planning (FP) policy covers the period 1990-2002, and focuses on macroeconomic influences, priority programs and gaps, adequacy of resources, equity and organizational aspects, and the process of policy formulation. The overall MCH/FP policy is well directed. MCH/FP has been a priority in all policies; resource allocation, although unacceptably low, has substantially increased during the last decade; and there is a progressive shift from MCH to the reproductive health (RH) agenda. Areas in need of improvement include greater use of evidence as a basis for policy; increased priority to nutrition programs, measures to reduce neonatal and perinatal mortality, provision of emergency obstetric care, availability of skilled birth attendants, and a clear policy on integrated management of childhood illnesses. Enhanced planning capacity, development of a balanced human resource, improved governance to reduce staff absenteeism and frequent transfers, and a greater role of the private sector in the provision of services are some organizational aspects that need the governments' consideration. There are several lessons to be learnt: (i) Ministries of Health need sustained stewardship and well-documented evidence to protect cuts in resource allocation; (ii) frequent policy announcement sends inappropriate signals to managers and weakens on-going implementation; (iii) MCH/FP policies unless informed by evidence and participation of interest groups are unlikely to address gaps in programs; (iv) distributional and equity objectives of MCH/FP be addressed while setting overall national goals; (v) institutional capacity is a vital ingredient in translating MCH/FP policies into effective services. The suggested strategic directions emphasize, among others, the need for a comprehensive MCH/FP framework; strengthened stewardship in ministry of health, cost-effective strategies to address the gaps identified and doubling of the public sector resource allocation to MCH/FP over the next 5 years. The ability to ensure delivery of quality health services remains the biggest challenge in the Pakistani health sector. Unless sound policies are backed by well-functioning programs they are likely to become a victim of poor implementation.

Adolescent↗
PubMed1993

Enteral nutrition following total laryngectomy.

Body composition was measured in patients who underwent total laryngectomy for carcinoma and who were enterally fed throughout the postoperative period with full liquid artificial mixtures. The intestinal complications were very mild and required no changes in the nutritional program. Body sector sizes remained essentially unchanged until the end of the support, malnutrition did not occur and the postoperative local infection rate was very low. On the contrary, in patients fed with blenderized food, the amount of enteral infusion had to be reduced because of poor tolerance or abdominal discomfort; in this case caloric intake was largely inadequate. Fall in BW and BCM size and increase of TBNa/TBK ratio demonstrated a postoperative impairment of the nutritional status. Furthermore, the postoperative infection rate, the number of days with fever and the length of antibioticotherapy were higher than those observed in patients fed with full liquid mixtures.

Aged↗