Abstract Type 2 diabetes mellitus (T2DM) is a long term metabolic disorder characterized by high blood sugar, insulin resistance, and relative lack of insulin. T2DM is a leading cause of cardiovascular disease, blindness, kidney failure, lower-limb amputation, and other complications that are costly to patients and the U.S. health care system. Lack of knowledge and underdeveloped skills for self-management of diabetes continues to be the biggest problem for patients with T2DM. Using a team approach and Rosswurm and Larrabee's (1999) conceptual model as a framework, the purpose of this doctorate of nursing practice quality improvement project was to develop an evidence-based initiative for diabetic self-management that included a practice guideline/protocol for patients, and an educational curriculum plan for staff members including a pretest/posttest. Two nurse practitioners who are specialists in diabetes served as content experts to evaluate the educational curriculum plan. A dichotomous 5-item evaluation revealed unanimous agreement that the objectives of the curriculum were met. The content experts validated each 15 pretest/posttest items using a 4-point Likert scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was equal to 1.00 showing each of the test items were very relevant. This project will promote positive social change by facilitating staff commitment to evidence-based practice which will impact the physical, psychological, and emotional well-being of patients, families, and communities.

Polypharmacy, the simultaneous use of multiple drugs to treat a single ailment or condition, is a major health problem among the elderly population that contributes to adverse drug side events, health risks, hospital readmissions, morbidity, and mortality. Therefore, a staff education program geared toward reduction of such adverse drug events was implemented at a single site. The purpose of the project was to determine if the staff education program would increase knowledge of adverse drug events due to geriatric polypharmacy. The Orem theory provided the theoretical support for the project, and the Iowa model guided the evidence-based practice change process. Topics covered in the education program included medication safety, appropriate drug usage, medication interactions, and other use issues of commonly prescribed drugs for elderly patients. Twenty staff members from 1 assisted-living facility were recruited for the education intervention. Assessments of staff member knowledge were collected before and after the education intervention. Descriptive statistics were used to compare preintervention and postintervention knowledge. Scores on the pretest ranged from 10% to 50% correct on the 10 items, and posttest scores ranged from 40% to 70% correct on the same items. The project is expected to produce social change due to reduced incidence of geriatric polypharmacy and, ultimately, decreased adverse drug effects resulting in patient morbidity, hospitalization, and mortality.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. Dietary habits may have an impact on COPD through anti-inflammatory mechanisms. For this cross-sectional secondary data analysis study, the advanced model of the epidemiology triangle was used as a guide to assess the association between total daily flavonoid intake and COPD diagnosis, COPD severity, systemic inflammation, and comorbidity burden. Data from over 5,100 male and female participants aged 30 and older were obtained from the 2007-2010 National Health and Nutrition Examination Survey. The prevalence of COPD was 5.2% according to spirometry data. Multiple logistic regression analysis showed that a 1% increase in total daily flavonoid intake resulted in a 5.9% decrease (95% CI [0.940, 0.943]) in the odds of having COPD after controlling for age, BMI, dietary fiber intake, education level, gender, race/ethnicity, and smoking status. After controlling for the same variables, multiple linear regression analyses showed that a 1% increase in total daily flavonoid intake among those with COPD resulted in a .00001 (95% CI [.001, .002], p < .001) increase in the percentage of the predicted FEV1 and a 0.076% decrease in C-reactive protein (95% CI [ .078, -.074], p < .001). A one-way ANOVA showed that total daily flavonoid intake was significantly (p < .001) different for each comorbidity burden level, and those with 2 or 3 comorbid diseases had significantly (p < .001) lower flavonoid intake than those with 1 or no comorbid diseases. These findings expand the knowledge of this topic and may effect positive social change by informing public health policies and interventions that aim to reduce COPD prevalence, morbidity, and mortality.

This study investigated genetic predictions for amino acid biosynthesis and catabolism by Lactobacillus helveticus CNRZ 32, a commercial cheese flavor adjunct that reduces bitterness and intensifies flavor notes. Conversion of amino acids into volatile and nonvolatile flavor compounds by L. helveticus and other lactic acid bacteria in cheese is thought to represent the rate-limiting step in the development of mature cheese flavor and aroma. One of the primary mechanisms for amino acid breakdown by these microbes involves the reversible action of enzymes involved in biosynthetic pathways, so our group investigated the genetics of amino acid biosynthesis in L. helveticus CNRZ 32. Most lactic acid bacteria are auxotrophic for several amino acids, and phenotypic characterization of L. helveticus CNRZ 32 has shown this bacterium requires 14 amino acids. Reconstruction of amino acid biosynthetic pathways from a draft-quality (incomplete) genome sequence for L. helveticus CNRZ 32 showed generally good agreement between gene content and phenotypic amino acid requirements. One exception involved the requirement ofCNRZ 32 for Asp (or Asn) for growth, where predictions derived from the genome sequence suggested this strain may be able to synthesize Asp from citrate. This prediction was confirmed as Asp auxotrophy in L. helveticus CNRZ 32 could be alleviated by the addition of citrate to a chemically defined medium that lacked Asp and Asn. Genome analysis also predicted that L. helveticus CNRZ 32 possessed ornithine decarboxylase activity, and would therefore catalyze the conversion of ornithine to putrescine, a volatile biogenic amine. Putrescine production in cheese would be undesirable because this compound may impart a rotting flesh flavor and can also have adverse effects on human health. Experiments to confirm ornithine decarboxylase activity in L. helveticus CNRZ 32 using a special growth medium, thin layer chromatography, high performance liquid chromatograph, or 13C nuclear magnetic resonance were unsuccessful, however, which indicated this bacterium does not contribute to putrescine production in cheese.

Three-day dietary records were analyzed for nutrient content and 24 hour urine samples were analyzed for calcium, phosphorous, total nitrogen, and free alpha-amino nitrogen for 210 elderly people. Dietaries and urine samples were collected twice, October and March at five month intervals, for each subject. Increases were found in both dietary intake and urinary components October to March. Based on a criteria of high dietary protein, low dietary calcium, high urinary nitrogen and low calcium, 23 subjects were selected as osteoporotic and and 25 were selected as non-osteoporotic. This method of prediction was not supported by radiological evaluations. Bone density and percent cortical area of the second metacarpal and the trabecular pattern of the femoral head were evaluated for each subject. A negative correlation of trabecular pattern with age indicated a general loss of bone with age. Decreased percent cortical area was the most consistent bone phenomena associated with osteoporosis. No significant difference was found between sexes in any of the radiological analysis. The osteoporotic condition is more closely associated with a loss of bone quantity than decreased bone quality. As yet, osteoporosis is not associated with specific nutrient(s) consumption or urinary excretion(s).

Current health recommendations encourage weight loss for overweight and obese individuals. However, the importance of weight to health is still unclear. The purpose of this study was to determine the impact of weight loss on overall health in a sample of adults who have completed a 10 or 12 week weight loss intervention. The study sample included males and females (n =99) between the ages of 27 -64 years that had a BMI of 29-45 kg/m². The study design is a secondary data analysis of data from two different behavioral weight loss interventions. Both interventions prescribed a reduced calorie diet, increased physical activity, and self-monitoring of diet and physical activity. Of the 99 participants, 28 lost greater than 5% of baseline body weight and saw the most significant changes in waist circumference (p<0.001), systolic blood pressure (p=0.004), diastolic blood pressure (p=0.002), and total cholesterol (p=0.001). This group experienced improvements in every lab value tested. More research with larger sample sizes and longer trial periods need to be done in order to strengthen the validity of the weight loss interventions.

The gut microbiota and its metabolites – namely short chain fatty acids (SCFAs) – interact with the digestive, immune, and nervous systems. Microbiota with disrupted composition are highly associated with obesity, gastrointestinal symptoms, and chronic inflammation. Levels of SCFAs in the feces can represent dynamics of the microbiota, and they represent one mechanism by which the microbiota interacts with its host. This study aimed to further our understanding of associations between microbiota bacterial diversity and SCFAs, immune markers, BMI, and GI symptoms and to identify bacteria that are differentially abundant in different BMI groups and with synbiotic supplementation. Data (SCFAs, immunoglobulins, body mass index, fecal fiber, fecal protein, measures of GI symptoms, and 16s RNA sequences, n=11) was extracted from a randomized control trial investigating the effects of synbiotic supplementation in non-celiac gluten-sensitive participants. QIIME2 was used to process 16s RNA data, analyze quantitative, qualitative, phylogenetic quantitative, and phylogenetic qualitative measures of alpha and beta diversity and to perform an analysis of composition of microbiomes (ANCOM) for identification of differential abundances. Multiple metrics of alpha diversity were found to significantly correlate with IgG4, IgM, IL-2, acetate, propionate, isobutyrate, valerate, isovalerate, caproate, heartburn, urgent need to defecate, and feelings of incomplete evacuation. Multiple metrics of beta diversity were significantly different between normal and overweight, normal and obese, and overweight and obese BMI classification groups. Beta diversity was also found to significantly correlate with IgG1, IgG3, IgG4, IgA, IL-6, IL-8, fecal fiber, propionate, butyrate, heartburn, acid regurgitation, nausea and vomiting, bloating, abdominal distension, increased gas, and eructation. The synbiotic intervention did not significantly alter alpha or beta diversity. An ANCOM identified bacterial taxa differentially abundant with BMI shifts and synbiotic supplementation, though these taxa were not those included in the synbiotic. Findings demonstrate alpha and beta diversity associations with various SCFAs, GI symptoms, immune markers, and BMI, and the results of the placebo-controlled intervention suggest careful consideration of placebo contents moving forward. This research supports plans to apply analysis to larger sample sizes to elucidate changes microbial profiles that are associated with clinically relevant biomarkers and symptoms.

Introduction: The gut microbiome is believed to have a significant impact on health throughout the lifespan, and the influence of infant nutrition and other environmental factors are of particular interest in its development. The aim of this research project was to learn more about the microbiome and short chain fatty acid (SCFA) composition of toddlers of differing weights, considering birth history, environment, and diet. In East Tennessee, opioid misuse is a growing issue, and a number of participants in this study were exposed in utero. We also hoped to identify related effects on infant’s SCFA composition. Finally, it is known that twins share a variety of traits, but much about their microbiome is unknown. With several pairs of twins in the sample, we aimed to identify any associations with SCFAs in this group. Methods: With informed consent, the child’s history was obtained, including age, birth length and weight, delivery type (C-section or vaginal), and feeding method (breast, bottle fed, or both). The child’s current weight, height, and BMI percentile were determined. Caregivers completed a 90-question Block Questionnaire for Ages 2-7 Kids food frequency questionnaire, and results were analyzed by Berkeley Analytics Inc (dba NutritionQuest). Participant-provided stool samples were freeze-dried and ground, and SCFAs were extracted and analyzed by content area % and concentration ppm. Data analysis was generated using SAS software, Version 9.4 of the SAS System, Copyright © 2013 SAS Institute Inc. Results: Nine SCFAs were measured in duplicate, and the concentrations averaged. Statistical analysis included comparisons of SCFAs related to factors including weight status, infant feeding modality, twin status, and intrauterine drug exposure, and significance determined with a p value < 0.05. Results did not identify significant differences in individual SCFA concentrations between obese and non-obese toddlers, however concentrations of isobutyrate, isovaleric acid, and octanoic acid were greater in toddlers who were formula fed as infants versus toddlers who were breastfed, and those fed a combination of breastmilk, and formula. Analysis further revealed a higher mean concentration of caproic and propionic acid in twin subjects. Of particular interest, toddlers with a history of opioid exposure had higher mean concentrations of isovaleric and octanoic acids, but less isocaproic acid when compared to those who were not drug exposed. Further analysis will help determine if these findings may be related to nutrient intake, in particular dietary fiber intake.

Breastfeeding reduces morbidity and mortality among mothers and children, yet African-American women breastfeed at lower rates than women of other racial and ethnic groups do. Higher rates of overweight, obesity, and low socioeconomic status may be contributing factors in this population; however, limited research exists regarding the roles of maternal overweight and obesity on breastfeeding outcomes. The purpose of this study was to examine whether social support and self-efficacy positively influence breastfeeding outcomes among overweight and obese African American women. Self-efficacy and social support theories provided the theoretical framework for the study. Research questions examined whether (a) maternal overweight and obesity, social support, and self-efficacy were associated with breastfeeding initiation and duration among African-American women; and (b) self-efficacy mediated this association. The study design was a quantitative retrospective analysis of a subset of secondary data from the 2009-2011 Pregnancy Risk Assessment Monitoring System (n = 10,926). SPSS 21.0-® was used for analyses. Obesity was significantly associated with breastfeeding durations of 9-16 weeks and 17 or more weeks. Self-efficacy was significantly associated with breastfeeding initiation only. Social support was negatively associated with breastfeeding durations of 9-16 weeks among obese women. Positive social change implications include increased knowledge of the associations between overweight, obesity, social support, self-efficacy, and breastfeeding outcomes among African-American women. This knowledge could be used to inform the development of interventions to improve breastfeeding and weight related health outcomes.

The importance of the gut microbiome is being explored in relation to multiple facets of health and performance. The purpose of this study was to explore the impact of frequent sweet potato ingestion on alterations of the gut microbiome which might in turn alter cholesterol levels and exercise performance. Thirteen recreationally trained males had fecal and blood samples collected and exercised to fatigue with and without exogenous carbohydrate ingestion prior to and following 42 days of daily sweet potato ingestion. Bacterial communities were extracted from fecal samples and bacterial DNA were sequence. Blood samples were analyzed for total cholesterol, low-density lipoprotein-C, high-density lipoprotein-C, and triglycerides. Performance was analyzed comparing changes in time-to-volitional fatigue with and without carbohydrate ingestion. Changes were observed in microbial abundance following 42 days of sweet potato ingestion but no differences in cholesterol or cycling fatigue with and without carbohydrates.