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PubMedDate not supplied

Promoting nutrition in breastfeeding women.

Nurses have a vital role in providing nutritional education to breastfeeding women. In this article, the authors discuss the nutritional requirements for breast-feeding women in terms of micronutrients, macronutrients, and minerals. They provide recommendations for women with vegetarian diets and low-income women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children program who may have dietary deficiencies, and they present a directed case study to provide an example of how to perform a dietary assessment and the educational support that may be offered by nurses to breastfeeding women.

Adult↗
PubMed2004

Nutrient intakes and food choices of infants and toddlers participating in WIC.

OBJECTIVES: To examine the nutrient intakes, foods consumed, and feeding patterns of infants and toddlers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: Cross-sectional telephone survey, including 24-hour dietary recalls of infants' and toddlers' food and nutrient intakes, as reported by parents or other primary caregivers. SUBJECTS: National random sample of 3,022 children ages 4 to 24 months who participated in the 2002 Feeding Infants and Toddlers study. Sample sizes by age were infants 4 to 6 months: 265 WIC participants, 597 nonparticipants; infants 7 to 11 months: 351 WIC participants, 808 nonparticipants; and toddlers 12 to 24 months: 205 WIC participants, 791 nonparticipants. STATISTICAL ANALYSES PERFORMED: We used Statistical Analysis Software (version 8.2) to examine the breastfeeding status, infant feeding patterns, and foods consumed; the personal computer version of the Software for Intake Distribution Estimation to estimate mean usual intake of food energy and of key nutrients targeted by the WIC program; and methods recommended by the Institute of Medicine to assess nutrient adequacy. RESULTS: Infants participating in WIC were less likely than nonparticipants to have ever been breastfed or to be currently breastfeeding, and they were more likely to be consuming formula. Mean usual nutrient intakes exceeded the adequate intake for WIC participants, and the percentage with inadequate nutrient intake was less than 1%. Reported mean energy intakes exceeded mean energy requirements, with the largest discrepancy observed for WIC participants. Sizeable proportions of WIC and non-WIC infants and toddlers did not consume fruits and vegetables on the recall day. APPLICATIONS: WIC providers should focus nutrition education on appropriate infant and toddler feeding patterns, should continue to reinforce their message of the importance delaying the use of cow's milk until 1 year of age, and should stress the importance of fruit and vegetable consumption.

Breast Feeding↗
PubMed1979

Evaluation of a group nutrition education approach to effective weight loss and control.

Fifty-three male officers of the Boston Police Department voluntarily participated in a 12-week nutrition program with weight control as a primary goal, and education in related health factors as a secondary goal. One year after graduation, 26 respondents to a survey reported losing an average additional 0.5 kg since graduation for a mean weight loss of 11.4 kg since their introduction into the classes. None had returned to their original weight status.

Body Weight↗
PubMed1997

The food-service industry, dietary guidelines and change.

The influence of the food-service industry on compliance with the Australian dietary guidelines was investigated through three separate methods of data collection and analysis: a telephone survey of 1683 randomly selected Brisbane residents; telephone interviews with 69 food-service-industry operators and 10 face-to-face interviews with key stakeholders in industry and government. Nearly 40 per cent of respondents had consumed foods prepared by the food-service industry at least once on the day before the interview, mainly from restaurants, cafes and takeaway shops, in the form of fast-food or snacks. Consumption of these foods declined with age. Those consuming foods prepared by the food-service industry ate significantly less fruit, vegetables and dairy food and were therefore less likely to comply with the dietary guidelines. Outcomes from interviews with operators in the food-service industry show that food choices offered to consumers were the result of a dynamic interaction between consumer demand and operators' own tastes and perceptions of food quality. Key informant interviews show that public health nutrition programs will have limited effect without supportive environmental changes in the food-service industry supply. An effective means of increasing the likelihood of compliance with the Australian dietary guidelines will be to encourage food suppliers in ways that address their core business concerns simultaneously with the goals of health professionals.

Adult↗
PubMedDate not supplied

Adapting and implementing a long-term nutrition and physical activity curriculum to a rural, low-income, biethnic community.

This study adapted an urban-based school nutrition program for delivery in a rural community. Specific aims were to adapt the curriculum; expand it to include physical activity; determine effectiveness on students' attitudes, knowledge, and self-efficacy; and assess teachers' impressions. Three cohorts were established: 173 students taught by a resource teacher, 170 students taught by classroom teachers, and 187 students who did not receive the curriculum. Pre- and posttest surveys measured outcomes, and classroom teachers were observed and interviewed. The curriculum was shown to be effective in enhancing student outcomes for both the resource teacher and classroom teacher cohorts. Teachers reported that lessons needed to be simplified and that children enjoyed them. Findings support the transferability of an urban-based nutrition curriculum to a rural community and the need for students to receive health education annually.

Child↗
PubMed1992

Prenatal programs: what the literature reveals.

OBJECTIVES: To review evaluations of prenatal health care programs, examine their methodologic features, and synthesize the findings of high-quality studies. DATA SOURCES: We combined a computerized search of the literature and recommendations of experts to select evaluations published between 1981-1991. METHODS OF STUDY SELECTION: After reviewing the quality of each evaluation in relation to methods and clinical applicability, we selected the highest-quality evaluations and summarized their methods and findings. DATA EXTRACTION AND SYNTHESIS: Trained researchers used a standardized abstraction form for information on main objectives and activities, setting, study design and sample, data collection methods, results, and conclusions. Seven of 22 evaluations met the review criteria. Maternal care coordination and visits by nurses, and specially targeted smoking and nutrition programs, were associated with optimized pregnancy outcomes for certain women, including the poor and very young. Longer participation in prenatal care was an important factor in achieving positive outcomes. Women receiving care from nurse-midwives did not differ in their pregnancy outcomes from women cared for by physicians. CONCLUSIONS: No evaluation met all the review criteria. Selection biases are likely, and thus positive findings may have reflected the types of women who were likely to comply with care rather than the effects of program participation. Many topics were not systematically evaluated. Carefully controlled evaluations of the content, number, and timing of prenatal care visits for women with differing medical and social risks are essential in identifying effective ways to achieve the nation's public health objectives regarding maternal and infant mortality.

Female↗
PubMed1983

Effect of nutrition staging on treatment delays and outcome in Stage IV neuroblastoma.

The effect of the state of nutrition of 18 children with Stage IV neuroblastoma at diagnosis and during initial therapy, was evaluated with respect to treatment delays, drug dosage alterations, tumor response, days to first event (relapse or death), and survival. All patients received similar therapy (CCSG protocol CCG 371). Based on nutrition staging at diagnosis, nine were classified as malnourished; four were randomized to receive total parenteral nutrition (TPN) and four peripheral parenteral nutrition plus enteral nutrition for 28 days (through 2 chemotherapy courses), and one died before randomization. Nine were nourished at diagnosis; seven received a comprehensive enteral nutrition program and two received TPN. By life-table analysis, the duration of remission was significantly greater in the nourished than the malnourished (P less than 0.01) and a trend towards improved survival was evident at one year (P = 0.08). The median length of survival for children nourished at diagnosis was approximately 12 months, whereas those malnourished had a median survival of only 5 months. Nine children remained nourished or were becoming renourished during the first 21 days of therapy, and one of these had treatment delays and decreased drug dosages. Seven were becoming malnourished or remained malnourished during this period and six had treatment delays (P less than 0.01). These data support the idea that nutrition staging at diagnosis and during initial treatment should be an integral part of protocol design and initial evaluation of children with Stage IV neuroblastoma.

Abdominal Neoplasms↗
PubMed1983

Spontaneous resolution of intestinal obstruction while receiving home parenteral nutrition.

Six patients with intestinal obstruction secondary to benign adhesions so dense and vascular that the operating surgeon could not free them, were placed on a home total parenteral nutrition program. Four patients had enterocutaneous fistulas, and two had their bowels divided and stomas created to divert intestinal contents from distal enterotomies made during the attempt to free the intestine. The enterocutaneous fistulas closed in four patients within 2 weeks to 5 months and the obstructions spontaneously resolved in 2 to 3.5 months. At reoperation on the two patients whose intestinal tracts were purposely divided, the previously matted bowels with dense adhesions were easily freed. We believe complete gastrointestinal rest allows adhesions to mature into long avascular collagen fibers in the absence of a persistent inflammatory reaction that accompanies partial or total small bowel obstruction. We recommend that patients receive 3 months of home total parenteral nutrition before a second operation for persistent obstruction after recent enterolysis should be considered. Spontaneous resolution should occur, but if not, reoperation can be performed safely after the 3 month interval.

Adult↗
PubMed1999

Nutritionally complete prepared meal plan to reduce cardiovascular risk factors: a randomized clinical trial.

OBJECTIVE: To compare a nutritionally complete prepared meal plan that meets national dietary guidelines to usual-care dietary therapy for hypertension, dyslipidemia, and glycemic control. DESIGN: Randomized, controlled trial. SUBJECTS/SETTING: Outpatients with hypertension, dyslipidemia, or diabetes mellitus (n = 251) were recruited at 6 medical centers in the United States and Canada. INTERVENTION: The prepared meal plan, which was developed by university-based nutrition and cardiovascular scientists and food technologists at Campbell's Center for Nutrition & Wellness (CCNW), provided the optimal levels of macronutrients and micronutrients recommended for cardiovascular risk reduction in a variety of prepackaged meals and snacks. After a 4-week pretrial period to assess baseline state, participants were randomized to the CCNW plan or "usual-care" diet for 10 weeks. MAIN OUTCOME MEASURES: Blood pressure, carbohydrate metabolism, lipoproteins, homocysteine, weight, nutrient intake, compliance. STATISTICAL ANALYSES PERFORMED: Repeated measures analysis of variance. RESULTS: Lipoproteins, carbohydrate metabolism, blood pressure, and weight improved on both plans. Mean differences (+/- standard deviation) between baseline and follow-up for the CCNW plan and the usual-care plan, respectively, were total cholesterol, -0.41 +/- 0.64 and -0.20 +/- 0.50 mmol/L (between-group P < .01); plasma glucose, -0.7 +/- 1.7 and -0.3 +/- 1.3 mmol/L (P < .05); systolic blood pressure, -5.2 +/- 10.0 and -4.7 +/- 9.0 mm Hg (P = .67), diastolic blood pressure, -3.8 +/- 5.9 and -2.2 +/- 5.5 mm Hg (P < .05); and homocysteine, -1.3 +/- 3.8 and 0.2 +/- 3.4 mumol/L (P < .01). The CCNW plan led to greater weight loss than the usual-care diet (-5.5 +/- 3.8 kg vs -3.0 +/- 3.2 kg, P < .0001). APPLICATIONS/CONCLUSION: The nutritionally complete CCNW plan offers greater improvements in lipids, blood sugars, homocysteine, and weight loss than usual-care diet therapy. This prepackaged comprehensive nutrition program can augment both the prescription and practice of optimal dietary therapy.

Adult↗
PubMed2003

Child participation in WIC: Medicaid costs and use of health care services.

OBJECTIVES: We used data from birth certificates, Medicaid, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to examine the relationship of child participation in WIC to Medicaid costs and use of health care services in North Carolina. METHODS: We linked Medicaid enrollment, Medicaid paid claims, and WIC participation files to birth certificates for children born in North Carolina in 1992. We used multiple regression analysis to estimate the effects of WIC participation on the use of health care services and Medicaid costs. RESULTS: Medicaid-enrolled children participating in the WIC program showed greater use of all types of health care services compared with Medicaid-enrolled children who were not WIC participants. CONCLUSIONS: The health care needs of low-income children who participate in WIC may be better met than those of low-income children not participating in WIC.

Birth Certificates↗
PubMed1998

Response to Edelstein: policy issues in early childhood caries.

This paper is a response to Dr Edelstein's paper on policy related to early childhood caries (ECC) and makes specific recommendations for policy that would have impact on ECC. The review by Dr Edelstein shows that currently there is little policy addressing the problems of ECC. The following specific policy suggestions are made: 1) Health Care Finance Administration should require the same accountability for well child dental checkups as they do for well child medical checkups; 2) The Special Supplemental Nutrition Program for Women, Infants and Children should include an oral health component in the physical evaluation visit; 3) The Centers for Disease Control and Prevention should set up a surveillance system for ECC; 4) continuing education courses should offer classes to health care workers in infant oral health; and 5) research must be aimed at practical preventive and treatment modalities.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Models for nutrition education to increase consumption of calcium and dairy products among African Americans.

Calcium and dairy consumption are documented to be low among African Americans and have demonstrated benefits to bone growth, overall nutritional status, and health throughout the life cycle. There is also an emerging relationship to the prevention of obesity. This low consumption has been attributed to both cultural and community/environmental barriers. Using a life course construct and an ecological model of health behavior, this paper will illustrate why nutrition education and food consumption behavior at one stage of the life cycle may influence health status at that stage as well as influence health and consumption of calcium and dairy products at subsequent stages. The life course construct recognizes that both past and present behavior and experiences (in this case food and nutrient intake) are shaped by the wider social, economic, and cultural context and therefore may provide clues to current patterns of health and disease. The ecological model, concerned with constructs of environmental change, behavior, and policies that may help people make choices in their daily life, complements the life course approach when examining the potential influence of nutrition education provided by federally funded food and nutrition programs on calcium and dairy consumption behavior across the life cycle. The "critical period model" within the life course construct is operative for calcium, a nutrient for which adequate intake is critically important during adolescence when peak bone density development, necessary for later protection against osteoporosis, is important.

Adult↗
PubMed2006

Body composition during the first year of life.

Knowledge of changes in body composition is of great potential benefit to the understanding of the nutritional needs and functional outcome of nutritional management for both healthy and sick infants. This review evaluates the different methods presently available to evaluate whole-body composition analysis based on different models, i.e. 2, 3, or more compartments. Analysis of the various approaches related to age, body weight and body length suggests that the major differences observed between the techniques could be preferentially related to differences in the population and that gender is one of the major determinants of whole-body composition during the first year of life. Among the techniques dual-energy X-ray absorptiometry (DEXA) and, more recently, air displacement plethysmography appear to be major techniques that have been evaluated in infants. Determination of weight gain composition is one of the major keys to the evaluation of the nutritional requirements, whereas the dynamic aspect during the first years of life could play a fundamental role in the nutritional programming of adult morbidity. Recent data suggest that protein intake and the protein:energy ratio are the main determinants of weight gain composition in preterm infants. Nevertheless, these data need to be confirmed in larger cohorts evaluated during the first year of life. To that, DEXA appears to be a useful technique to obtain sequential analysis of weight gain composition over a longer period of time and in a less invasive fashion.

Body Composition↗
PubMedDate not supplied

Total parenteral nutrition with different ratios of fat/carbohydrate at two energy levels: an animal study.

Different regimens of total parenteral nutrition were evaluated in 64 growing rats, during a 10-day period. Thirty-two rats were kept at a low energy regimen (270 kcal/kg body weight per day), and the remaining rats were infused with a high energy solution (350 kcal/kg/day). At each energy level, four fat/carbohydrate (CHO) nonprotein energy ratios were tested: 0% fat/100% CHO (no fat); 6% fat/94% CHO (low fat); 30% fat/70% CHO (medium fat); 60% fat/40% CHO (high fat). A daily supply of 0.9 g nitrogen/kg of a well balanced amino acid solution was administered to all rats. Growth, nitrogen balance, net nitrogen utilization, and blood status were evaluated. Carcass, liver, and muscle composition were investigated with respect to protein, fat, and water content. Liver and body composition was similar between groups at the same energy level. At the higher energy level the fat deposition was increased. At the low energy level, rats from no fat and low fat groups lost weight during the first 3 days of the experimental period. The medium fat groups showed the highest weight gain at each energy level. This suggests the importance of the presence of fat in total parenteral nutrition programs. During the last days of the experimental period, all rats gained weight, and showed a positive nitrogen balance. All groups given 350 kcal/kg/day gained weight more rapidly and showed a better nitrogen balance and utilization than the corresponding group given 270 kcal/kg/day. This study emphasizes that a well-balanced proportion of energy and substrates is important.

Animals↗
PubMed1999

Home parenteral nutrition in children: the Polish experience.

BACKGROUND: Home parenteral nutrition has become routine for management of intestinal failure in patients. In Poland the main obstacle to widespread use of home parenteral nutrition is the lack of interest of commercial companies in delivering feedings and ancillaries to patients. METHODS: Twenty-five home parenteral nutrition patients aged from 4 months to more than 13 years were reviewed. The mother or both parents were trained in home parenteral nutrition techniques for 4 to 6 weeks and compounded the nutrients themselves at home. RESULTS: The mean duration of home parenteral nutrition was 10,117 patient days. Hospital stays of patients receiving parenteral feedings were significantly shorter than the duration of administration of home parenteral nutrition (p < 0.001). Eleven children are continuing the home parenteral nutrition program. Eighty-three catheters were used in these patients. The rate of catheter occlusion decreased within the observation period, and in 1997 not one case of occlusion was observed. In 1997 only three catheters were removed during 7.8 patient years, and the overall incidence of catheter-related complications was 0.38 per patient year. The overall occurrence of septicemia was one case in 516 days and of catheter infection was one in 459 days. In 1997 a catheter was infected on average of once every 1419 days. There was significant improvement in the z score for weight during therapy. The average monthly cost of nutrients and ancillary items was approximately $1200 (4200 Polish zlotys [PLN]). These costs are 1.6 to 3 times lower than those recorded in other studies. CONCLUSION: Home parenteral nutrition in children with nutrients mixed by caregivers in the home setting is a safe and appropriate method of treatment that can be used in countries where home parenteral nutrition solutions are not manufactured or where commercial home parenteral nutrition is not economically feasible.

Adolescent↗
PubMed2001

Weightlessness as an accelerated model of nutritional disturbances.

Food intake and eating patterns, body functions and composition are significantly altered by short-duration space flight. Prolonged missions lasting weeks or months further aggravate these changes, and are responsible for acute or chronic physical impairments at return to ground conditions. Current projects of missions to Mars, resulting in 2 years of microgravity conditions, stress the critical need for the development of optimal nutritional programs and physical countermeasures to prevent body mass and function alterations. This review outlines ground models of microgravity simulation, summarizes the major effects of weightlessness on body composition, protein metabolism, hormonal pattern, and muscle function, and addresses contradictory findings related to the oxidative stress secondary to space flight. Potential countermeasures, such as nutrient intake and physical conditioning, as well as areas of interest for future research both in ground and space medicine, are discussed.

Animals↗
PubMed2002

Food security and nutritional outcomes of preschool-age Mexican-American children.

OBJECTIVE: To examine the relationship of food insecurity to nutrition of Mexican-American preschoolers. DESIGN: Cross-sectional survey of low-income Mexican-American families with children of preschool age (3 to 6 years). Data included food security using the Radimer/ Cornell scale; acculturation; parental education; monthly income; past experience of food insecurity; and child weight, height, and frequency of consuming 57 foods. Weight-for-height z scores (WHZ), height- for-age z (HAZ) scores, and the percentage of overweight (> or = 85th percentile WHZ) were calculated. SUBJECTS/SETTING: A convenience sample of Mexican-American families (n=211) was recruited through Head Start, Healthy Start, Migrant Education, and the Special Supplemental Nutrition Program for Women, Infants, and Children in Tulare, Fresno, Monterey, and Kern counties in California. Statistical analyses Analysis of variance, t tests, Spearman's correlations, and Mantel Haenszel chi2. RESULTS: Limited education, lack of English proficiency, and low income were negatively correlated with food security (r = -0.31 to -0.44, P<.0001). After controlling for acculturation, children in severely food-insecure households were less likely to meet Food Guide Pyramid guidelines than other children (median number of food groups > or = recommended levels [interquartile range]: 2.0 (2.0) vs 3.0 (2.0), P<.006). Although WHZ (mean +/- SD = 1.28 +/- 1.80) and percent overweight (48%, N=19) tended to peak among children from household level food insecure families, no significant differences were found in weight or height status of children by level of food insecurity. APPLICATIONS/CONCLUSIONS: Dietetics professionals working with low-income Hispanic-American families should screen for different levels of food insecurity to determine needs for nutrition education and other services.

Acculturation↗
PubMedDate not supplied

Effects of psychosocial risk factors and prenatal interventions on birth weight: evidence from New Jersey's HealthStart program.

CONTEXT: Many states developed and implemented multifaceted Medicaid prenatal care programs in the late 1980s in response to expansions in Medicaid eligibility. Although these new programs were based on the presumed relationships between psychosocial risk factors, early prenatal care, prenatal interventions and birth outcomes, research has not verified all of these linkages. METHODS: Data were collected on 90,117 women who took part in New Jersey's comprehensive prenatal care program, HealthStart, between 1988 and 1996. The impact of psychosocial risk factors and prenatal interventions on mean birth weight and the odds of low birth weight (less than 2,500 g) was assessed using ordinary least-squares regression and logistic regression, respectively. RESULTS: After controls were introduced for social and demographic, psychosocial and behavioral factors, as well as the woman's county of residence and the year of her baby's birth, smoking, drinking and using hard drugs (but not marijuana) during pregnancy were independently associated with reductions in mean birth weight (of 123g, 29g and 137g, respectively) and with increases in the odds of low birth weight (odds ratios, 1.4, 1.2 and 1.7, respectively). However, according to the fully adjusted model, which also controlled for medical risk factors and prenatal services, the interventions designed to reduce those behaviors had no favorable effects on birth weight. In contrast, the receipt of services in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was associated with an increase in mean birth weight of 22g (and of 48g among inadequately nourished women only), and with a reduction in the risk of low birth weight (odds ratio, 0.87). CONCLUSION: Referrals to WIC services should be a key feature of prenatal care programs for poor women.

Adult↗