The aim of the present study was to determine the effect of vitamin D supplementation (4000 IU or 6000 IU of cholecalciferol daily for 6 months) on fasting plasma glucose, fasting insulin, glycated hemoglobin, and lipid profile in a sample of African-Americans and Hispanics with T2D and vitamin D insufficiency. Seventy five participants were recruited by community outreach. Plasma glucose concentration was measured by hexokinase enzymatic method. Glycated hemoglobin was measured by the DCA2000+ system. Insulin in fasting blood was determined by radioimmunoassay. Plasma total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein cholesterol were assayed by enzymatic methods. Serum vitamin D concentrations were measured with an enzyme-immunoassay kit. Mixed model was used to compare treatment effects and Bonferroni multiple comparison tests was used to detect significant changes from baseline, 3 months, and 6 months on the outcome variables. Significant improvements in serum 25(OH)D levels were seen from baseline to 3 month and 6 months respectively in both treatments (from 22.25 ± 7.19 to 37.34 ± 12.31 and 37.99 ± 13.22, PPP=0.040) was observed. Similarly, a significant change in serum triglycerides was observed at 6 months in the 6000 IU group (from 201.44 ± 91.35 to 172.92 ± 76.87 mg/dl, P=0.037). However, when the model was adjusted for confounders, significance was lost. Vitamin D supplementation did not improve glucose homeostasis in this sample. The positive effect of vitamin D supplementation on lipid profile may be mediated by other cofactors related to vitamin D metabolism.

Factors associated with and barriers to participation in Supplemental Nutrition Assistance Program (SNAP) and the effect participation has on food security, nutrition status, disease status and quality of life was investigated in a cross-sectional study including 175 HIV infected individuals. In addition, the effect of a targeted nutrition education on nutrition knowledge, readiness to dietary behavior change, nutrition status, disease status and quality of life was also investigated among a subset of the population (N = 45) in a randomized clinical control trial. SNAP participation rate was 70.3%, similar to the State of Florida and national participation rates. SNAP participation was positively and independently associated with being born in the US (P < 0.001), having monthly income less than $1000 (P = 0.006), and receiving antiretroviral treatment (P < 0.001). Participation barriers include denial of participation by program, recent incarceration, living in a shelter where participation is not allowed and unawareness of eligibility status. In regression analyses, SNAP participation was not significantly associated with improved food security, nutrition status, disease status and health related quality of life (HRQOL). Over half (56%) of the population experienced food insecurity and had inadequate intakes of half of the nutrients assessed. Illicit drug, alcohol and cigarette use were high in this population (31%, 55% and 63% respectively), and affected food security, nutrients intake, disease status and HRQOL. The nutrition education intervention resulted in a trend towards improvements nutrition knowledge, self-efficacy, and readiness to change without impacting nutrition status, disease state and quality of life. Food insecurity and other nutrition related issues, with implications for treatment, management and cost of HIV disease, continue to plague infected individuals living in poverty. More resources, including food and nutrition programs, specifically targeted towards this population are needed to address these issues.

This study used the 1987-88 USDA Nationwide Food Consumption Survey to investigate the contribution meat products make to intakes of nutrients at risk of inadequate or excessive consumption by women. The study is unique in that meat nutrients were extracted from mixed dishes, providing a more accurate picture of consumption. Cluster analysis was used to classify nonpregnant, nonlactating women 19 years and older based on their consumption patterns of total meat and individual meats (beef, poultry, processed meats, pork and seafoods) as percent of caloric intake. Total fat and SFA intakes exceeded National Research Council (NRC) goals regardless of meat intake level. Results indicate an inverse relationship of total energy intake and calories from all meats. Total fat intakes had a small, positive relationship with meat calories. Saturated fatty acid (SFA) intakes appeared to have a weak, positive relationship. Vitamin B6 intakes were below the RDA in all clusters but were adequate relative to protein intakes. Iron intakes of women under age 51 were less than 70% of RDA. Zinc had a strong, positive association with total meat intake. Individuals that did not consume beef met only 48% to 62% of RDA. An analysis to determine if increases in vitamin 86, iron, and zinc seen with high meat intake were due to increased meat or caloric intake showed that total fat and SFA increased 12% and 8%, respectively, when ≤ 2 ounces of meat and ≤ 6 ounces of meat were consumed. All of the increase was derived from meat. Vitamin B6, iron, and zinc increased 100%, 59%, and 132%, respectively; 77%, 64%, and 90% were due to meat. In summary, women's diets were significantly low in iron and zinc, which are strongly present in meat products, especially beef. Intakes of vitamin B6 appear to meet calculated needs, but some women may be at risk due to the increased requirements found with age and the low bioavailabilty of plant sources. Attempting to reduce total fat and SFA intakes by reducing meat intake, especially red meat, may have a deleterious effect on women's nutrient status.

Food insecure individuals do not always have access to adequate food for a healthy lifestyle and are at high risk of detrimental health outcomes. Researchers hypothesize that food insecurity leads to changes in dietary practices, including greater overall food purchase in times of adequate resources and purchase of low-cost, unhealthful foods when resources are constrained. Most measures of food insecurity do not measure changes in dietary practices and dietary quality. Research findings suggest education that provides alternative strategies to manage resources and improve dietary practices can improve food insecurity. We assessed the relationship between 1) food security and ability to afford foods and 2) the impact of Expanded Food and Nutrition Education Program (EFNEP) in a low-income, multi-cultural population in Massachusetts. We used a pre/post-education survey design, including the USDA six-item Food Security Module (FSM), food-affordability questions and EFNEP behavior checklist. EFNEP participants experienced high rates of food insecurity with over 40% of participants classified as food insecure (N=80). Pre-EFNEP, individuals in households with low food security were less likely to report being able to afford healthy foods (51.5%) and fruits and vegetables (57.6%) throughout the month compared to those in households with high (80.9%) and marginal (78.7%) food security (P=0.007, P=0.051). Individuals in households with marginal, low and very low food security were less likely to report being able to afford the same kinds of food throughout the month compared to individuals in high food secure households (56.4% vs. 84%) (P=0.022). Individuals in food insecure households reported running out of food before the end of the month more often than their food secure peers (P=0.013). Post-EFNEP, a greater proportion of participants fell into the high and marginal categories of food security (60.0% to 71.7%, P=0.065). Our results indicate that food insecure households have a harder time affording healthy foods throughout the month, leading to poor diet quality that possibly contributes to poor health outcomes. The food affordability questions may capture changes in dietary practices in food insecure populations throughout the month. EFNEP can provide skills and knowledge to at risk populations to improve abilities and combat food insecurity.

Background: A significant portion of lactating women in less developed countries have vitamin A (VA) deficiency. Lactation has substantial effects on a mother’s metabolism and VA is known to be needed in multiple biological processes, including growth, vision, immunity, and reproduction. Objective: The objective of this pilot study was to utilize metabolomics profiling to conduct a broad, exploratory assessment of differences in plasma metabolites associated with low VA status versus adequacy in lactating women. Methods: Plasma samples from lactating women who participated in a survey in Samar, Philippines, were selected from a cross-sectional study based on plasma retinol concentrations indicating low (VA-; n=5) or adequate (VA+; n=5) VA status (plasma retinol <0.7 or >1.05 µmol/L). The plasma results collected from six metabolomics assays (oxylipins, endocannabinoids, bile acids, primary metabolomics, aminomics, and lipidomics) were compared by group, using liquid chromatography mass spectrometry. Results: Twenty-eight metabolites were significantly different in the VA- versus VA+ status, with 24 being lipid mediators (p<0.05). The lipid mediators demonstrated lower concentrations of the arachidonic acid- and eicosapentaenoic acid-derived oxylipins, as well as lysophospholipids and sphingolipids, in the VA- group (p<0.05). Chemical similarity enrichment analysis identified HETEs, HEPEs, and DiHETEs as significantly different oxylipin clusters (p<0.0001, false discovery rate (FDR) p<0.0001), as well as sphingomyelins, saturated lysophosphatidylcholines, phosphatidylcholines, and phosphatidylethanolamines (p<0.001, FDR p<0.01). Conclusions: The multi-assay nutritional metabolomics profiling of low VA status compared with adequacy in lactating women demonstrated reduced lipid mediator concentrations. Future studies with stronger study designs and a large and more diverse population are needed to validate these preliminary results.

Vitamin D deficiency is considered to be a pandemic with implications for compromised bone health and other chronic diseases. Few studies have examined vitamin D status in college-aged individuals where prevention of future health consequences is still possible. Serum vitamin D 25(OH)D status and vitamin D intake were examined in 98 college students ages 18-29 years during winter. BMI was classified as < 25and 25 or greater. Race was categorized as Caucasian or other. Overall, 69.5% had suboptimal serum vitamin D levels, <30ng/mL. Only 8 students (8.2%) met the EAR (400 IU) per day for vitamin D intake. t tests were used to determine if there were significant differences in serum vitamin D level and dietary intake based on gender, race and BMI. Significant differences were found in serum vitamin D level when compared by gender and race. Females tended to have a higher serum vitamin D level than males. Those representing minorities had lower serum vitamin D levels than Caucasians; One hundred percent of the minority students had suboptimal serum vitamin D levels. Based on these findings, dietitians should increase efforts to target college-aged individuals in educational programming related to factors affecting vitamin D synthesis, vitamin D intake, and health consequences of suboptimal vitamin D status, particularly in winter. Consideration should be given to vitamin D fortification of foods that meet the preferences of today’s consumer.

This study was conducted to determine the impact of nutrition edu cation on participants of the Supplemental Food Program for Women, Infants and Children (WIC) and the Expanded Food and Nutrition Education Program (EFNEP). The specific objectives were to: 1) determine the impact of participation in EFNEP on iron status as assessed by hematocrit (hct) and ferritin levels; 2) determine the effect of nutrition knowledge on hct and ferritin values; and 3) determine the effect dietary behavior has on hct and ferritin levels for both WIC and EFNEP participants. Each study participant completed a 24-hour dietary recall record plus food frequency record, medical history, validated nutrition knowledge test, and finger stick blood sample prior to program enrollment or nutrition education, and again six months later. There were 42 WIC, 26 EFNEP, 23 WIC-control, and 23 EFNEP-control participants. Paired t-tests were used to find differences between preprogram and postprogram evaluation scores for the variables of nutrition knowledge score, hematocrit level, ferritin level, and levels of several nutrients. Nutrition knowledge test scores increased significantly from preprogram to postprogram for both WIC and EFNEP participants (14.2 ± 3.27 to 15.5 ± 2.89 for WIC, 14.2 ± 3.77 to 15.6 ± 2.79 for EFNEP). EFNEP participants also increased significantly in hct levels (38.5% ± 3.78 to 40.7% ± 2.13). Hematocrit levels did not change significantly for the WIC or control groups and nutrition knowledge did not increase for the control group between preprogram and postprogram evaluations. Mean intakes of vitamin A, vitamin c, calcium, and protein were above the RDA at preprogram and postprogram evaluations, yet the percentage of individual participants who consumed less than 67% of the RDA in this study was higher than in the continuing survey of Food Intake of Individuals - 1985. Improvement in nutrient intake at postprogram evaluations was encouraging. Regression analysis indicated that nutrition education classes in college, income level, and level of formal education each had a positive effect on nutrient intake and nutrition knowledge.

Background: Hispanics are the largest minority group in the U.S. and by the year 2060 the number of Hispanics is projected to double. They are disproportionately affected by obesity and chronic diseases which translate into decreased quality of life, loss of work opportunities and perceptions of injustice for the Hispanic population. The Dietary Guidelines (DG) provide information to help Americans make healthy food and physical activity choices and if followed can be a means of reducing the health disparity gap. However, culturally relevant recommendations specific to Hispanics’ health and nutritional habits are often lacking. The purpose of this study was to examine Hispanics’ knowledge, perceptions, benefits and barriers to the recommendations in the DG for Americans, Choose MyPlate, and the Department of Health and Human Services physical activity guidelines. Methods: A qualitative research design was used. Focus groups were conducted in Spanish and audiotapes were transcribed and then, translated into English. Thematic analysis was used to identify different key concepts subgrouping these topics according to common emergent themes. Results: A total of 24 participants took part in the study. Participants viewed healthy eating in terms of portion sizes. They viewed the DG as helpful but felt they needed more information to follow the guidelines. Several barriers were identified in following the MyPlate: lack of availability of healthy, fresh, inexpensive grocery options in Hispanic neighborhoods. Participants described the benefits of physical activity as related to improved mental health and quality of life such as looking and feeling better. Conclusion and Implications: Promoting nutrition education that is culturally and linguistically appropriate for Hispanics might help facilitate the adoption of the DG and MyPlate recommendations. Also, improving the design of existing low-income neighborhoods is still a challenge to improve participation in physical activity among Hispanics’.

This thesis examines the trajectory of food politics and its relationship with modernizing food landscapes. Today’s food politics discussions in the US and other high-income countries lean towards concerns with social issues, while in the recent past it was more focused on producing enough food to feed the growing population – two different situations with important concerns. The question this thesis explores is whether the modernization of society has given us a higher level of wellbeing and a better world through food landscapes and food policy, and how we came up with the current food situations we face today. It looks into the food landscape and policies of the US and its implications on wellbeing, and the dietary transition of Japan, comparing it to other modernized countries. It is important to look at these factors of food politics to see how other countries may handle a food transition, and whether or not there is a direction all countries can go in that will better benefit its food landscapes. Concerns not only lie in producing sufficient yields but also in wellbeing, cultural values, and true consumer demands. Only when true consumer demands are acknowledged individually can the trajectory of food politics be better harnessed and guided to a more desirable outcome than it has been going in so far.

Magister Scientiae (Nutrition Management) - MSc(NM) / Introduction: The provision of quality nutrition care services is needed to address the national burden of diseases, and to reduce under- and overnutrition in South Africa. Globally, there is a lack of information and data about the perceptions, experience of, and satisfaction with the quality of nutrition care services, both from patients and dietitians. Patients and dietitians are in the best position to provide useful information pertaining to their perception and experience of nutrition care service delivery. The aim of this study was to determine the perceptions of patients and dietitians on the quality of nutrition care service delivery in the Klipfontein/Mitchells Plain Sub-Structure (KMPSS). Methodology: This cross-sectional descriptive study design employed a mixed method approach. All patients consulted by the dietitians on the dates of data collection were conveniently sampled (n=120) across three Primary Health Care facilities in KMPSS (Hanover Park Community Health Centre (CHC), Mitchells Plain CHC and Heideveld Community Day Centre (CDC)) for participation in the quantitative component of the study. An interview-administered survey was used to gather information about patients’ perceptions and experiences of nutrition care services. For the qualitative component, an all-inclusive sample of the four dietitians’ employed in KMPSS participated in a Focus Group Discussion (FGD). The FGD included open-endAnalysis: The Statistical Package for Social Sciences (SPSS) software was used to generate descriptive statistics for the quantitative data. Thematic analysis was used for the transcriptions of the FGD audio-recordings. The themes and sub-themes was identified through summaries and key findings on the perceptions of the quality of nutrition care service delivery through views and opinions.ed questions developed by the researcher to explore the perceptions of the dietitians on the quality of nutrition care service delivery. Results: The quantitative results found that participants strongly agreed with positive statements regarding the dietitians’ interpersonal skills, manner in which they presented themselves, and communicating health information. Nearly 80% of the participants perceived dietitians as being well presented, courteous, friendly, and polite, created a comfortable environment and were always on time for their appointments. Eighty percent (80%) of the participants were also satisfied with the nutrition care services provided by the dietitians in KMPSS. The qualitative findings revealed that the dietitians’ had both negative and positive perceptions of the nutrition care service delivered within KMPSS. The dietitians’ expressed the need to improve the quality of nutrition care through management making and availability of necessary resources. This would enhance their work performance, communication and leadership skills. Conclusion: The key results and findings of this study concur with other research that has been done within the dietetics profession. There is a need to promote quality nutrition care in dietetics by utilizing perceptions and experiences of patients and dietitians. It is imperative for continuous quality improvement initiatives in nutrition care to improve patient health outcomes in South Africa.