Master of Public Health - MPH / The burden of malnutrition continues to persist and is the major cause of morbidity and mortality in children. According to the results of the Zimbabwe Multiple indicator cluster survey in 2019, stunting remains high at (26.8%) and the leading form of malnutrition, affecting 1 in 3 children less than 5 years in Zimbabwe. Suboptimal feeding practices have been identified as one of the many causes of malnutrition. Various studies have shown that many risk factors of malnutrition can be addressed during the crucial first 1000 days of life. Cultural beliefs, values, and practices play a vital role in the pre and postnatal period. However, there is a knowledge gap in how culture influences the caregivers regarding feeding and dietary intake. Therefore, the study’s major aim was to explore the cultural beliefs and practices of caregivers of malnourished children between 6-24 months, regarding dietary intake and feeding practices in Gweru, Zimbabwe.

The purpose of this study was to examine the effects of socio- viii demographic characteristics, knowledge of coronary heart disease and behavior variables on blood cholesterol concentration among 218 selected subjects in northern Utah connnunities. The data were obtained from physicians' medical charts and a survey specifically designed for this study. A model was developed from an intensive review of literature and the current state of theoretical and empirical knowledge and was tested by means of path analysis. The model contained fourteen variables including familial coronary heart disease heredity, sex, age, the presence of disease(s), educational attainment, special dietary regimen, occupation, knowledge about coronary heart disease, Type A/B behavior patterns, attitude toward low-fat, low-cholesterol diets, saturated fat calorie intake, energy expenditure, relative body weight, and blood cholesterolconcentration. The model was evaluated for the entire sample as well as two subsamples of males and females. It was found that there was a strong causal relationship between the level of education and knowledge about coronary heart disease (CHD), and between its knowledge and attitude toward low-fat, low-cholesterol diets (less atherogenic diets). Furthermore, it was observed that a favorable positive attitude toward low-fat, low-cholesterol diets served directly to decrease the relative body weight. On the other hand, estimated expenditure of total energy was increased with increasing knowledge about coronary heart disease and in physically active occupations. There was a negative association between the estimated total energy expenditure and blood cholesterol concentration, while a weak positive relationship of relative body weight and saturated fat intake on cholesterol concentration in the blood was observed. Not only knowledge about coronary heart disease had a direct influence on attitude, but also age had a positive causal effect on attitude toward low-fat, low-cholesterol diets. The direct association of familial coronary heart disease heritability on blood cholesterol concentration was the strongest among other variables, followed by special diets, age, total energy expenditure, and saturated fat intake. About 28% of the variations in the blood cholesterol concentration among the entire sample could be explained by eleven variables combined compared with 36% for females and 23% for males. It was shown in the likelihood ratio test that the influence of social and demographic characteristics, knowledge about coronary heart disease, and behavior variables on blood cholesterol concentration was not significantly different between male and female samples. In conclusion, this research suggests the direction and magnitude of causal relationships between socio-demographic characteristics, knowledge of coronary heart disease and behavior variables and serum cholesterol concentration. Therefore, the findings of this study indicate the potential value of educational programs for the coronary heart disease prevention.

Recent nutrition reports conclude that changing dietary practices is a strategic way to reduce cancer rates in the United States. Nutrition recommendations to decrease risk of cancer include reducing fat intake to 30% of total calories, increasing fiber consumption to 20-30 g/day, and increasing fruit and vegetable consumption to five servings daily. However, recent studies suggest that fruit and vegetable consumption decreases with educational and income levels within a population, and that blue-collar workers tend to consume 38-40% of total calories as fat. It is possible that national campaign efforts to change dietary practices are not reaching educationally and economically challenged populations. This research identifies the perceptions of blue-collar workers regarding a link between dietary practices and disease prevention. Six focus groups, three of women and three of men were conducted in urban, suburban, and rural Virginia counties. A total of 66 workers participated, and each group was comprised of 8-16 blue-collar workers 35-65 years of age. Most participants were aware of a link between dietary practices and health. A "healthy person" was described as eating low fat foods, fruits and vegetables, and maintaining a healthy weight. Fatty meat consumption, food processing, and chemical treatment of food were perceived as increasing risk for disease. Few participants were aware of a potential link between diet and cancer. Many contributed risk for cancer to factors beyond their control such as heredity, environmental factors, and the influence of the food industry. Those who had experienced a disease, either themselves or through a loved one expressed a greater sense of urgency to modify their eating habits. Most of those attempting dietary modification were addressing health issues relating to cardiovascular disease. The majority reported consuming less than five servings of fruits and vegetables daily, most often as canned or frozen products. Participants reported receiving nutrition education from non-interactive sources, such as television, newspapers, magazines, and radio, and interactive sources such as health professionals and community programs. Those that mentioned interactive sources were more likely to elaborate on specific information learned. Television segments, newsletters, and worksite programs were selected as the most preferred ways to receive nutrition education. When asked what topics would be most helpful in a newsletter series, people requested information regarding heart disease more frequently than cancer. Health benefits of fruit and vegetable consumption, menus, and recipes were also mentioned. The findings suggest that nutrition education efforts concerning cardiovascular disease have penetrated the blue collar population. Community educators need to broaden messages to include current information regarding the potential link between dietary practices and cancer. Furthermore, 35-65 year olds may exhibit more willingness to change dietary habits through nutrition education due to changes in health among themselves or loved ones. / Master of Science

The aim of this study was to develop, implement and evaluate the effectiveness of a behavior based, theory driven multi-component nutrition education Intervention promoting healthy eating among two (17 to 19 year old) Lebanese adolescent samples from contrasting socioeconomic statuses. The effects of the intervention were examined in a quasi-experimental control design trial among two hundred and nine adolescent males and females from Beirut, Lebanon: one hundred and ten belonged to a high socioeconomic status (HSES) population and ninety nine belonged to a low socioeconomic status (LSES) population of adolescents. There were four study groups: two intervention and two control. The intervention groups received twelve nutrition lessons, one hour each, involving class based teaching, print materials and activities delivered by a dietitian. Intervention Mapping protocol was applied and constructs from the Social Cognitive Theory were used for the development of the intervention. At baseline and after the intervention, food frequency questionnaires (FFQ) were administered and three 24-Hour Dietary Recalls were used to examine dietary practices and nutrient intakes while semistructured interviews were conducted to gain insight to underlying determinants of food choice. Quantitative data were analyzed using Mann Whitney U Test and Chi-Square analysis. Post intervention, adolescents in both the HSES and LSES intervention groups showed a significant improvement (p<0.05) in some dietary practices and nutrient intakes; however, the impact was higher in the HSES group. In both intervention groups, positive changes were observed in some personal determinants of food choice but none were noted for external factors. These results propose that the developed nutrition education intervention is a promising instrument to promote healthy eating among similar groups of Lebanese adolescents; however, further research is needed for interventions that specifically target LSES groups.

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.

Com o objetivo de conhecer a prática alimentar, a atividade fÍsICA e o gasto energético de adolescentes, de ambos os sexos, inseridos ou não no mercado de trabalho, administraram-se questionários auto-aplicáveis a 273 estudantes, do período noturno, de seis escolas da Rede Estadual de Ensino de Santo André - SP. Estudantes trabalhadores (163) , ou seja, que recebiam remuneração por serviços prestados, mantinham-se em atividades ocupacionais pelo período de 40 a 50 horas semanais, percebendo de 1 a 3 salários mínimos por mês. Os meninos participavam, proporcionalmente, mais no mercado de trabalho formal que as meninas. Foram relatadas todas as atividades fisicas desempenhadas segundo número de dias por semana e horas por dia. Entre as várias atividades discriminadas, destacou-se assistir televisão, como prática comum a todos os estudantes, independentemente de gênero e de inserção ou não no trabalho. Outras atividades assinaladas mostraram-se estatisticamente independentes do fato de trabalhar ou não, porém, foi detectada, para algumas, associação com gênero, tais como prática esportiva (meninos) e afazeres domésticos (meninas) . O gasto energético diário referente à atividade física foi estimado com base nos diferentes movimentos, ponderados por tempo e nos fatores atividades da FAO/OMS/UNU. Os valores encontrados foram 3150 e 2160 Cal para estudantes masculinos e femininos, respectivamente. A prática alimentar foi analisada sob o aspecto qualitativo da dieta habitual, utilizando, como padrão, uma adaptação do Food Guide pyramid. Não foram observadas associações estatisticamente significativas entre trabalhar e apresentar dieta inadequada para os grupos de alimento de carnes e de cereais, ao contrário do verificado entre os grupos de frutas e de verduras, cujo teste estatístico indicou haver associação. / A group of 273 students of evening courses of 6 State Public schools, located in the city of Santo André, State of São Paulo, Brazil, was analyzed, aiming to know their dietary practices, physical activities and energy expenditures. One hundred and sixty three adolescents were workers and their occupational activities last for 40 to 50 hours per week; they earned from 1 to 3 living wages. Proportionally, male adolescents were more engaged in the formal workmanship than girls. All their physical activities were described and draw the attention \"watching TV\" as the most frequent for both sexes and workers or not. Other activities were statistically associated to gender but independent to the fact of being a worker (boys were more related to sports and girls to housekeeping). The daily energy expenditure related to physical activities was calculated based on the FAO/WHO/UNU movement-factors indicators, and the values of 3000 and 2100 Cal were estimated for boys and girls, respectively. Dietary practices, by the point of view of quality, were analyzed, using one adaptation of the Food Guide Pyramid. Statistical association was not found between inadequate diets and workers when meat and cereals were observed; the opposite occurred when fruits and vegetables were taken in account, statistical association was detected.

Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Objectives: Children with autism spectrum disorder (ASD) are known to have feeding difficulties. This study gathered information from parents/caregivers with children diagnosed with ASD. The following aspects were investigated: early feeding history, food preferences, sensory issues, current dietary practices and the use of nutritional supplements and special diets. The study also gathered information regarding these families’ experience with dietitians in supporting them with advice related to dietary problems. Methodology: An online questionnaire was used and the link to the study was placed on the National Autistic Society (NAS) of the United Kingdom’s website to recruit participants. Parents/ caregivers of children aged between 3-16 years and diagnosed with ASD, who resided in England, could take part in the study. Results: Three hundred and twenty five parents/ caregivers participated in the study. The mean age of children was 9.5 years. The majority of children were male (85%). The most common feeding problem was the transition from stage 1 weaning foods to more textured food (55.6%). Sensory problems played a large role in food acceptance. Clear preferences were made for crunchy (81.5%) or dry foods (79%), followed by food with a smooth consistency (69.8%) such as yogurt. Food appearance and presentation (64%) was the main determinant of food acceptance and specific brands and packaging played a major role. Habitual food intake and continually choosing the same foods for meals were present in the majority of children (75.6%). Specific preference was given to the following foods: starchy vegetables (62.6%), refined carbohydrates (81%), processed meat products (69.2%) and dairy products (68.6%). The use of ‘special’ and exclusion diets were not popular. However, where specifically gluten and/ or casein were excluded (19%, n=55), it was generally excluded for more than one year. Reported observations with these exclusions were: improvement in bowel habits, sleep, concentration, behaviour and social communication. The use of nutritional supplements were significantly higher (p<0.5) where exclusion diets were used. A large number of children (43.4%, n=23) on exclusion diets, have not been consulted by a dietitian. Most parents /caregivers (58.1%) had the perception that dietitians were lacking knowledge of ASD and had inadequate knowledge of current dietary interventions for children with ASD (61.7%). However, parents felt that it was reassuring to consult a dietitian, that practical advice was given to improve dietary intake and that generally it reduced their concern regarding their child’s dietary intake. Conclusion: The study highlights the complexity of ASD and the variable effect it has on eating, behaviour and dietary intake. The use of the gluten and casein free (GFCF) diet may improve general wellbeing in some children with ASD when used appropriately and warrants further investigation. It is concerning that only a minority of children on exclusion diets are consulted by dietitians to ensure nutritional adequacy. Due to the complexity of ASD and in the absence of clear guidance for dietary interventions, dietitians who work with children with ASD need to be supported by continued training opportunities in order to enhance their competencies and optimise their service delivery. / AFRIKAANSE OPSOMMING: Doelwitte: Kinders wat aan Outismespektrum-steuring (OSS) lei is geneig om voedingsprobleme te hê. Die studie het inligting ingesamel van ouers en versorgers met kinders wat met OSS gediagnoseer is. Die volgende aspekte is ondersoek: vroeë voedingsgeskiedenis, voedsel voorkeure, sensoriese probleme, huidige eetgewoontes en die gebruik van nutriëntaanvullings en spesiale diëte. Die studie het ook inligting ingesamel aangaande gesinne se ondervinding met dieetkundiges en ondersteuning met dieetprobleme. Metodologie: ‘n Elektroniese vraellys is gebruik en die skakel na die studie was op die webwerf van die National Autistic Society (NAS) van die Verenigde Koninkryk geplaas om deelnemers te werf. Ouers/ versorgers van kinders tussen die ouderdomme van 3-16 jaar, met ‘n diagnose van OSS en woonagtig in Engeland, kon deelneem aan die studie. Resultate: Drie honderd vyf en twintig ouers/ versorgers het deelgeneem aan die studie. Die gemiddelde ouderdom van die kinders was 9.5 jaar en 85% was manlik. Die mees algemene voedingsprobleem vir kinders met OSS was die oorgangsfase van gladde speningsvoedsel na growwer voedsel (55.6%). Sensoriese probleme het ‘n groot rol gespeel in voedselaanvaarding. Daar was duidelike voorkeure vir bros (81.5%) en droë voedsel (79%), gevolg deur voedsel met ‘n gladde tekstuur soos jogurt (69.8%). Die voorkoms en aanbieding van voedsel het grootliks bepaal of voedsel aanvaarbaar (64%) is. Spesifieke handelsmerke of verpakkings het ‘n groot rol gespeel (64.7%). Die meeste van die kinders (75.6%) het vaste eetgewoontes gehad en dieselfde kos tydens maaltye gekies. Die volgende voedselsoorte was verkies: styselryke groente (62.6%), verfynde koolhidrate (81%), geprosesseerde vleis produkte (69.2%) en suiwel produkte (68.6%). Die gebruik van spesiale en uitsluitingsdiëte was ongewild. Waar gluten- en kaseïen-uitsluitingsdiëte (19%, n=55) gebruik is, is dit meestal vir langer as een jaar gebruik. Met die gebruik van uitsluitingsdiëte is verbeteringe waargeneem in stoelgang gewoontes, slaap, konsentrasie, gedrag en sosiale kommunikasie. Die gebruik van nutriëntsupplemente was beduidend hoër (p<0.5) in die groep waar uitsluitingsdiëte gebruik is. ‘n Hoë persentasie kinders (43.4%, n=23) wat op uitsluitingsdiëte was, is nie deur dieetkundiges gekonsulteer nie. Die meeste ouers /versorgers (58.1%) het gevoel dat dieetkundiges gebrekkige kennis oor OSS en dieetverwante probleme het, asook onvoldoende kennis van huidige dieet intervensies vir kinders met OSS (61.7%). Ouers het wel gevoel dat dit gerusstellend was om dieetkundiges te gaan spreek vir praktiese raad om dieet inname te verbeter. Dit het ook hul kommer veminder aangaande kinders se diëte. Gevolgtrekking: Die studie benadruk die kompleksiteit van OSS en die wisselende effek wat dit op eetgewoontes, gedrag en voedsel inname het. Die gebruik van die gluten- en kaseïenvrye diëte kan moontlik die gesondheid en welsyn van sommige kinders met outisme verbeter mits dit reg gebruik word, maar vereis verdere navorsing. Dit was kommerwekkend dat ‘n minderheid van die kinders op uitsluitingsdiëte deur dieetkundiges gekonsulteer word om voldoende nutriëntinname te verseker. Aangesien OSS ‘n komplekse toestand is en daar ‘n gebrek is aan duidelike riglyne vir dieet intervensies, word dit aanbeveel dat dieetkundiges wat met kinders met OSS werk ondersteun word deur opleidingsgeleenthede om hul vaardighede te verbeter en dienslewering te optimaliseer.

Com o objetivo de conhecer a prática alimentar, a atividade fÍsICA e o gasto energético de adolescentes, de ambos os sexos, inseridos ou não no mercado de trabalho, administraram-se questionários auto-aplicáveis a 273 estudantes, do período noturno, de seis escolas da Rede Estadual de Ensino de Santo André - SP. Estudantes trabalhadores (163) , ou seja, que recebiam remuneração por serviços prestados, mantinham-se em atividades ocupacionais pelo período de 40 a 50 horas semanais, percebendo de 1 a 3 salários mínimos por mês. Os meninos participavam, proporcionalmente, mais no mercado de trabalho formal que as meninas. Foram relatadas todas as atividades fisicas desempenhadas segundo número de dias por semana e horas por dia. Entre as várias atividades discriminadas, destacou-se assistir televisão, como prática comum a todos os estudantes, independentemente de gênero e de inserção ou não no trabalho. Outras atividades assinaladas mostraram-se estatisticamente independentes do fato de trabalhar ou não, porém, foi detectada, para algumas, associação com gênero, tais como prática esportiva (meninos) e afazeres domésticos (meninas) . O gasto energético diário referente à atividade física foi estimado com base nos diferentes movimentos, ponderados por tempo e nos fatores atividades da FAO/OMS/UNU. Os valores encontrados foram 3150 e 2160 Cal para estudantes masculinos e femininos, respectivamente. A prática alimentar foi analisada sob o aspecto qualitativo da dieta habitual, utilizando, como padrão, uma adaptação do Food Guide pyramid. Não foram observadas associações estatisticamente significativas entre trabalhar e apresentar dieta inadequada para os grupos de alimento de carnes e de cereais, ao contrário do verificado entre os grupos de frutas e de verduras, cujo teste estatístico indicou haver associação. / A group of 273 students of evening courses of 6 State Public schools, located in the city of Santo André, State of São Paulo, Brazil, was analyzed, aiming to know their dietary practices, physical activities and energy expenditures. One hundred and sixty three adolescents were workers and their occupational activities last for 40 to 50 hours per week; they earned from 1 to 3 living wages. Proportionally, male adolescents were more engaged in the formal workmanship than girls. All their physical activities were described and draw the attention \"watching TV\" as the most frequent for both sexes and workers or not. Other activities were statistically associated to gender but independent to the fact of being a worker (boys were more related to sports and girls to housekeeping). The daily energy expenditure related to physical activities was calculated based on the FAO/WHO/UNU movement-factors indicators, and the values of 3000 and 2100 Cal were estimated for boys and girls, respectively. Dietary practices, by the point of view of quality, were analyzed, using one adaptation of the Food Guide Pyramid. Statistical association was not found between inadequate diets and workers when meat and cereals were observed; the opposite occurred when fruits and vegetables were taken in account, statistical association was detected.

Le diabète est en progression au Bénin et sa prévalence est passée de 2,9% en 2008 à 12,4% en 2015. Or, il existe peu de données sur les facteurs favorisant ou aggravant la gestion de cette maladie. Cette recherche vise à évaluer les pratiques alimentaires des diabétiques et leur prise en charge nutritionnelle au Bénin. Une étude transversale auprès de 252 diabétiques âgés de 18 ans et plus suivis au Centre National Hospitalier Universitaire (CNHU) et à la banque d’insuline de Cotonou a été réalisée. Des rappels de 24h, des questionnaires et des mesures d’hémoglobine glyquée ont été colligés auprès des diabétiques et des entrevues ont été réalisées auprès de 18 professionnels de santé. Des analyse statistiques ont permis de rechercher les associations entre les pratiques alimentaires et la gestion du diabète et une grille d’analyse a permis de qualifier leur prise en charge nutritionnelle. Dans l’ensemble, les individus suivis au CNHU gèrent mieux leur diabète que ceux de la banque d’insuline. Il existe une différence significative dans la gestion du diabète selon l’âge et la profession. Les pratiques alimentaires sont surtout basées sur la cuisine maison mais les plats cuisinés souffrent de diversité. Peu de diabétiques ont une bonne gestion de leur diabète et ceux-ci reçoivent une prise en charge nutritionnelle déficiente variant d’un centre de diabétologie à l’autre. Il est important de mieux étudier les pratiques alimentaires des diabétiques, de standardiser la prise en charge nutritionnelle et de recruter des nutritionnistes dans les services de diabétologie au Bénin. / Diabetes is on the rise in Benin and its prevalence increased from 2.9% in 2008 to 12.4% in 2015. There is little information on the factors promoting or aggravating diabetes management. This research aims to evaluate the dietary practices of diabetics and their nutritional management by health professionals in Benin. We conducted a cross-sectional study of 252 diabetics aged 18 years and older followed at the Centre National Hospitalier Universitaire (CNHU) and the Cotonou insulin bank. Questionnaires, 24-hour recalls and glycated hemoglobin measurements were collected among the diabetics. Semi-directed interviews were also conducted with 18 health professionals. Statistical analyses were used to test for associations between dietary practices and diabetes management, and an analytical grid was used to qualify their nutritional management by health professionals. Overall, individuals monitored at the CNHU managed their diabetes better than those at the insulin bank. There is a significant difference in diabetes management by age and occupation. Dietary practices are mainly based on home-cooking, but dishes suffer from diversity. Few diabetics have good management of their diabetes and they receive poor nutritional management that varies from one diabetes centre to another. This study highlights the need to better study the dietary practices of diabetics, to standardize nutritional care and to recruit nutritionists in the diabetes services in Benin.

Racial/ethnic groups are disproportionately affected by obesity and other risk factors for chronic diseases. African immigrants are an increasing segment of the U.S. population at greater risk for obesity than other immigrants living in the United States. Public health organizations that aid immigrants could benefit from information about changing dietary patterns. The purpose of this study was to explore the association between dietary acculturation and obesity among African immigrant adults living in the United States, controlling for length of stay, English proficiency, region of residence, and other sociodemographic factors. Acculturation theory guided this study. The research design was quantitative cross-sectional with secondary data from 798 adult immigrants of African origin who completed the New Immigrant Survey. Forward stepwise logistic regression analyses indicated that when controlling for sociodemographic factors, dietary acculturation was a significant predictor of obesity. Language proficiency, income, marital status, childhood living environment, and age were statistically significant predictors of obesity. Findings may be used by clinicians, dieticians, and other health care professionals to develop obesity prevention and control strategies that specifically serve African immigrants to prevent obesity and its associated deadly complications.