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The family heart dietary intervention program: community response and characteristics of joining and nonjoining families.

A random sample of 501 eligible families was selected from a designated neighborhood in Portland, Oregon, and given the opportunity to join a 5-year intervention program promoting a low-fat and low-cholesterol eating pattern designed to reduce risk for coronary heart disease. Participation entailed three baseline assessments of clinical, dietary, and psychological indices, periodic follow-up measurements, and monthly small group meetings led by psychologists and nutritionists. A prior home health survey allowed comparisons of respondents from joining and nonjoining families in terms of reported health status, health beliefs, health locus of control, knowledge about health and nutrition, and demographic characteristics. Almost half (47%) of all invited families agreed to join this long-term nutrition intervention program and completed the necessary baseline assessments. Factors discriminating joiners and nonjoiners were not generally consistent with the health belief model of preventive health behavior. Joiners were similar to nonjoiners in terms of perceived susceptibility to disease, family health histories, and reports of elevated plasma cholesterol levels in the family. However, families with hypertensive members were less likely to join this heart disease prevention program. Positive predictors of participation included higher occupational status, greater knowledge about heart disease, a more internal health locus of control, and the belief that there are few barriers preventing the adoption of a healthier low-fat eating pattern. These findings indicate that there is widespread community interest in optimal nutrition, and they also provide suggestions as to what motivates the general public to take preventive health actions.

Adolescent↗

[Nutritional rehabilitation of undernourished and nutritionally at-risk children admitted to a supplementary food program in Mogi das Cruzes, São Paulo, Brazil].

This study aimed to evaluate the nutritional rehabilitation of undernourished children admitted to a program entitled Incentives to Fight Nutritional Deficiencies (ICCN) in Mogi das Cruzes, São Paulo, Brazil. The study included 724 children (6 to 24 months old) from July 1999 to July 2001. The indices used to evaluate baseline nutritional status were weight-for-age, weight-for-length, and length-for-age, defining normal as z score > or = -1, at-risk as > or = -2 and < -1, moderate malnutrition as < -2 and > -3, and severe malnutrition as < or = -3. Nutritional evolution was evaluated using the length-for-age index, and the results were analyzed considering the average z score variation at the end of the 12-month program. After 12 months, nutritional status had improved in all categories, while the best results were in children with more intense baseline nutritional deficiency. Gains in length were 1.12, 0.82, 0.57, and 0.45 z scores for the severe and moderate malnutrition, nutritional risk, and normal categories, respectively. The ICCN in Mogi das Cruzes thus demonstrated effective nutritional improvement for program beneficiaries.

Body Height↗

Field gleaning as a tool for addressing food security at the local level: case study.

Field gleaning, or harvesting crops after the commercial harvest, has been promoted as a way to increase food security; however, the effectiveness of gleaning programs is not well documented. The purpose of this research was to explore the impact of gleaning on individual gleaners and the community by documenting total amounts gleaned, individual uses of produce, and self-reported benefits and barriers to gleaning. During the 1997 season, approximately 50 gleaners participated in the Pierce County Expanded Food and Nutrition Education Program Gleaning Project; 29 participated in an intensive 4-week study to track use of produce by gleaners. Onsite weighing of gleaned produce revealed that of the 110,000 pounds gleaned by these 50 gleaners from Pierce County farms and orchards during 1997, 85,000 pounds (77%) were donated to local emergency food programs; 25,000 pounds (23%) were taken home by gleaners. Of the produce taken home by the 29 study participants, an estimated 9% was used fresh, 48% was preserved for later user, and 43% was shared with others. During a combination of telephone and in-person interviews, gleaners reported using more fresh produce and sharing knowledge about gardening and food preservation. The most important benefits of gleaning were "stretching my food budget" and "helping provide food for the community." Detailed exploration of the impact of gleaned produce on dietary patterns and use of validated food security measures is warranted considering the volume of produce used fresh, preserved for later use, and given away by gleaning participants.

Adolescent↗

Polio as a platform: using national immunization days to deliver vitamin A supplements.

In 1988 the 41st World Health Assembly committed WHO to the goal of global eradication of poliomyelitis by 2000 "in ways which strengthen national immunization programmes and health infrastructure". The successful use of polio National Immunization Days (NIDs) to deliver vitamin A is an example of how polio eradication can serve as a platform to address other problems of child health. Importantly, this integration is helping to achieve the World Summit for Children goal of eliminating vitamin A deficiency by the year 2000. It is estimated that between 140 million and 250 million preschool children are at risk of subclinical vitamin A deficiency. In 1998 more than 60 million children at risk received vitamin A supplements during polio national immunization days (NIDs). While food fortification and dietary approaches are fundamental to combating vitamin A deficiency, the administration of vitamin A supplements during NIDs helps raise awareness, enhance technical capacity, improve assessment and establish a reporting system. Moreover, polio NIDs provide an entry point for the sustainable provision of vitamin A supplements with routine immunization services and demonstrate how immunization campaigns can be used for the delivery of other preventive health services.

Child↗

Historical assessment of nutrition studies using only African-American study subjects: gender, socioeconomic status, and geographic location.

While the African-American community has disproportionate rates of morbidity and mortality from chronic diet-related diseases, few studies have examined demographically the spectrum of these outcomes in the population. The purpose of this study is to determine the extent to which published scientific literature has examined African-American samples with sufficient specificity to identify nutrition problems in subsets of the population. Age, gender, socioeconomic status, geographic location, and sample size are used to examine study questions. In addition, the United States Department of Agriculture (USDA) Continuing Survey of Food Intakes for Individuals (CSFII) 1994-1996 is used to illustrate how evaluating nutrient variables by demographic indicators provides insights into the heterogeneity of nutrient intake patterns among African Americans. Relative to the adequacy of scientific investigation into these issues, a review of twenty-nine studies conducted from 1970 to the present demonstrates bias in gender, income, and sample size for African-Americans-only dietary research samples. Relative to identifying dietary patterns that do not meet US dietary guidelines, pervasive patterns that persist across income groups were found, indicating the need for nutrition education programs at all levels. Although there are science based diet information available, it does not seem to have reached the African-American community in numbers sufficient to be reflected in dietary changes as reported by surveys. This research demonstrates the need for detailed studies highlighting these issues, as well as the production of culturally appropriate nutrition education materials and methods that will be effective in reaching this population.

Black or African American↗

[The training programs for correction of the nutritional disturbances behavior in patients with arterial hypertension and diabetes mellitus type 2].

The aim of the present study is to evaluate the alimentary disorders in patients with high risk for cardiovascular diseases, also in patients with arterial hypertension (AH) and njn--insulin-diabetes mellitus (DM). The results showed that patients with AH (155 patients) and DM (107 patients) have high prevalence of the alimentary disorders: high consumption of total fat--46% (DM) and 70.9% (AH), high consumption of carbohydrates--14.9% and 73%, salt intake--34.9% and 68.6%, respectively. Application of special training programs in groups provided stable modification of dietary habits and was more effective, compared with the traditional ones. These groups demonstrated better results in dietary habits modification, compared with the existing routine individual medical control groups.

Adult↗

Comparison of energy and nutrient intakes among meals and snacks of adolescent males.

BACKGROUND: Eating behaviors developed during adolescence can have immediate health implications and influence future chronic disease risk. The objectives of this study were to determine and compare the distribution of energy and nutrient intakes among meals and snacks, and relate eating occasion frequency to body mass index (BMI) of adolescent males. METHODS: Healthy adolescent males (n = 180) completed 3-day food records. Following analysis for energy and nutrient intakes, 3-day averages and frequencies were computed for all meals and snacks. RESULTS: Dinner was the largest contributor of energy, macronutrients, cholesterol, dietary fiber, and sodium, whereas both dinner and breakfast were the largest contributors of calcium and iron. On average, subjects consumed 1.63 snacks/day, with 77% consuming > or = 1 snack/day. BMI was significantly greater and energy intake was significantly lower in subjects having < or = 3 eating occasions/day relative to 4 or > or = 6 eating occasions/day. The 26% of subjects classified as inconsistent breakfast consumers had significantly higher BMIs and lower iron intakes relative to consistent breakfast consumers. CONCLUSIONS: This study provides valuable information regarding eating occasion frequency and contribution of meals and snacks to energy and nutrient intakes in adolescent males. Such information could be used to improve nutrition education programs for adolescents aimed at chronic disease prevention.

Adolescent↗

Disordered eating and the female athlete triad.

Female athletes are under intense pressure to have a low percentage of body fat for performance, which may result in a vulnerable athlete resorting to disordered eating, developing amenorrhea, and suffering the consequences of osteoporosis. Prevention of disordered eating practices among female athletes requires a de-emphasis of a low percentage of body fat and a good nutrition education program. The female athlete triad is a serious syndrome that requires a multidisciplinary approach to diagnosis and treatment.

Amenorrhea↗

Nutritional status of young children in AIDS-affected households and controls in Uganda.

This study conducted in Uganda assessed the nutritional status of young children and their disease history in the 3-month period before the study. Two groups of children were randomly selected: the first group consisted of 105 children living in homes where a family member fell sick of AIDS, whereas the second group consisted of 100 children who were living in homes where nobody was affected by AIDS. Acute malnutrition (wasting) was rare. There was no difference in the severity of stunting in the two groups (Z scores, -2.1 versus -2.2, P = 0.70). In those children living in AIDS-affected homes, disease episodes were longer (15.7 versus 11.3 days, P = 0.014), but the frequency of disease occurrence was similar in both groups. Fifty-five percent of all children suffered from moderate to severe malnutrition (stunting). The high stunting rate in early childhood suggests a public nutritional intervention program is recommended.

Acquired Immunodeficiency Syndrome↗

Observation versus self-report: validation of a consumer food behavior questionnaire.

A reliable and validated set of food safety behavior questions that could be used with confidence when evaluating food safety education programs was identified in this study. A list of 29 food-handling and consumption behaviors rank-ordered within five pathogen control factors by nationally recognized food safety experts was the basis for the development of the behavior questions. Questions were evaluated for reliability and several forms of validity. During a kitchen activity session, 70 graduates of a nutrition education program completed four food preparation tasks while being observed and videotaped. The individuals also participated in an in-depth interview to validate behaviors that could not be observed during the food preparation activity, e.g., refraining from preparing food for others when experiencing diarrhea. Criterion validity was established by comparing questionnaire responses to observed behavior and interview responses. Twenty-eight questions met the validity criterion (> or = 70% agreement between observed and interviewed responses and self-reported responses), with three or more questions from each of five pathogen control factor areas. Observation assessments revealed that hand washing was more likely to be performed prior to beginning food preparation than between working with raw meats and fresh produce. Errors in methods of washing hands, utensils, and preparation surfaces between food preparation tasks were common. Most participants did not use thermometers to evaluate doneness but still cooked to safe internal temperatures. The results provide a tool that educators can use to evaluate food safety programs and will help guide the development of more effective food safety education programs targeting needed improvements in behavioral skills.

Adult↗

Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption.

OBJECTIVE: To examine the self-reported importance of taste, nutrition, cost, convenience, and weight control on personal dietary choices and whether these factors vary across demographic groups, are associated with lifestyle choices related to health (termed health lifestyle), and actually predict eating behavior. DESIGN: Data are based on responses to 2 self-administered cross-sectional surveys. The main outcomes measured were consumption of fruits and vegetables, fast foods, cheese, and breakfast cereals, which were determined on the basis of responses to questions about usual and recent consumption and a food diary. SUBJECTS/SETTING: Respondents were a national sample of 2,967 adults. Response rates were 71% to the first survey and 77% to the second survey (which was sent to people who completed the first survey). STATISTICAL ANALYSES: Univariate analyses were used to describe importance ratings, bivariate analyses (correlations and t tests) were used to examine demographic and lifestyle differences on importance measures, and multivariate analyses (general linear models) were used to predict lifestyle cluster membership and food consumption. RESULTS: Respondents reported that taste is the most important influence on their food choices, followed by cost. Demographic and health lifestyle differences were evident across all 5 importance measures. The importance of nutrition and the importance of weight control were predicted best by subject's membership in a particular health lifestyle cluster. When eating behaviors were examined, demographic measures and membership in a health lifestyle cluster predicted consumption of fruits and vegetables, fast foods, cheese, and breakfast cereal. The importance placed on taste, nutrition, cost, convenience, and weight control also predicted types of foods consumed. APPLICATIONS: Our results suggest that nutritional concerns, per sc, are of less relevance to most people than taste and cost. One implication is that nutrition education programs should attempt to design and promote nutritious diets as being tasty and inexpensive.

Adult↗

"Achieving Health for All": a framework for nutrition in health promotion.

Achieving Health for All, a document released by Health and Welfare Canada, is a framework for nutrition in health promotion. Specific examples of the nutrition implications of the framework's challenges, mechanisms, and strategies are presented. Opportunities for involvement by individual dietitians/nutritionists as well as for The Canadian Dietetic Association are highlighted.

Canada↗

Social-cognitive determinants of nutrition behavior among supermarket food shoppers: a structural equation analysis.

A social-cognitive model of nutrition behavior (A. Bandura, 1997) was tested using structural equation modeling of data from 307 food shoppers recruited from 5 supermarkets in Southwest Virginia. The shoppers were participating in the baseline phase of an ongoing nutrition promotion program. As part of the evaluation, data were collected on the self-efficacy and outcome-expectations components of social-cognitive theory as well as on food purchases and intake. The structural analyses presented here support the social-cognitive model. Self-efficacy, physical outcome expectations, age, socioeconomic status, and number of children were important predictors of nutrition behavior among shoppers. Implications for interventions using social-cognitive variables to improve the nutritional content of food purchases and intake are discussed.

Adult↗

Field experience for community nutrition students.

A cooperative project was undertaken by university community nutrition students and Montgomery County, Maryland, school food service personnel. Although such projects can be extremely beneficial as learning experiences for students, care must be taken to limit their scope to the level and the time available to the students. School food service staffs cannot expect such projects to provide manpower resulting in detailed scientific studies; however, school food service programs can benefit from the observations made by students.

Child↗

Study of serum zinc in relation to nutritional status among thalassemia patients in Damanhour Medical National Institute.

Thalassemia results from an imbalance between two proteins in hemoglobin called alpha and beta globin that interferes with cell maturation and function resulting in an ineffective erythropoeisis and hemolysis. Zinc is an essential element that supports normal growth and development. In thalassemia, the expected low serum zinc level is due to hemolysis, loss in urine and inadequate dietary intake. To evaluate serum zinc levels among thalassemia patients and study its relation to nutritional status and growth, a case control study was conducted at Damanhour Medical National Institute. Forty-six thalassemia patients were randomly selected from the attendants of the Hematology Unit and were compared to 20 control children. They were subjected to medical history and examination, anthropometric measurements, assessment of dietary profile, laboratory investigations for CBC, total serum protein, serum albumin, serum zinc. The mean age was 8.29 +/- 3.96 years for cases and 8.45 +/- 3.52 years for controls. Thalassemia patients showed significant lower serum zinc level when compared to and 8.45 +/- 3.52 years for controls. Thalassemia patients showed significant lower serum zinc level when compared to control (88.28 +/- 17.76 microg/dl), and (113.5 +/- 15.39 microg/dl) respectively A positive correlation was found between their serum level and height/age (r = 0.392). Zinc supplementation and nutrition education program are recommended to improve growth rate among thalassemia patients with retarded growth ad low serum zinc levels.

Body Height↗

Community-acquired pneumonia in older people: the need for a broader perspective.

Community-acquired pneumonia (CAP) poses a substantial threat to the health of older adults. The incidence of this infection and mortality associated with it increase with age. Despite the considerable effect of CAP on older adults, little is known about the effect of socioeconomic and environmental factors on CAP in older people. This paper argues that broader determinants, including socioeconomic status (SES), nutrition, and factors in the physical environment such as exposure to tobacco smoke and air pollution need to be evaluated as potential risk factors for CAP in older adults. Data suggesting a relationship between low SES and risk of acquiring CAP exist; possible causal pathways include increased exposure through crowding or increased susceptibility to infection. Inadequate nutrition, exposure to tobacco smoke, air pollution, and not receiving immunization may predispose older people to lower respiratory tract infection. This study reviews current evidence for these potential risk factors and suggests priorities for research. A thorough understanding of these factors and their underlying biological mechanisms is needed to develop successful health-promotion strategies such as better immunization strategies and educational programs about nutrition. Determining the effect of air pollution on CAP in older adults is important in terms of reducing personal risk to older individuals and for healthcare agencies charged with formulating policy to protect the health of older adults.

Aged↗

Coverage and cost of iodized oil capsule distribution in Tanzania.

Distribution of oral iodized oil capsules (IOC) is an important intervention in areas with iodine deficiency disorders (IDD) and low coverage of iodized salt. The mean reported coverage of 57 IOC distribution campaigns from 1986-1994 of people aged 1-45 years in 27 districts of Tanzania was 64% (range 20-96%). This declined over subsequent distribution rounds. However, due to delayed repeat distribution, only 43% of person-time was covered, based on the programme objective of giving two IOC (total 400 mg iodine) at 2-year intervals. Three different capsule distribution strategies used in 20 distribution rounds in 1992-1993 were analyzed in depth. Withdrawal of financial support for district distribution expenses under the 'district team' strategy, and the subsequent change to integrated 'primary health care' distribution, increased delays and capsule wastage. The third, more vertical strategy, 'national and district teams', accomplished rapid distribution of IOC about to expire and subsequently a return to the initial 'district team' allowance strategy was made. Annual cost of 'district team' distribution was 26 cents per person (400 mg iodine/2 years). Cost analysis revealed that the IOC itself accounts for more than 90% of total costs at the levels of coverage achieved. IOC will be important in the elimination of IDD in target areas of severe iodine deficiency and insufficient use of iodized salt, provided that high coverage can be achieved. Campaign distribution of medication with high item cost and long distribution intervals may be more cost-effectively performed if separated from regular PHC services at their present resource level. However, motivating health workers and community leaders to do adequate social mobilization remains crucial even if logistics are vertically organized. Insufficient support of distribution expenses and health education may lead to overall wastage of resources.

Adolescent↗