Cardiac disease is the primary cause of death in the United States of America (CDC, 2017). Despite ongoing efforts and investments to improve cardiac health in the United States, most of the population will suffer from cardiovascular diseases. There is a multitude of research supporting that diet can contribute to cardiac disease, but it is less known that diet can greatly contribute to regulation and reversal of cardiovascular disease processes (Huang et al., 2012; Satija et al., 2017; Kim et al., 2019). Existing research supports the efficacy of plant-based diets to manage and reverse certain cardiac diseases (Tuso et al., 2015; Esselstyn, 1999; Ornish 1998; Campbell et al., 1998). Plant-based diets have the potential to save many lives and drastically reduce healthcare costs. The purpose of this literature review is to evaluate current research on plant-based diets as interventions for cardiac disease and to identify the reasoning for underutilization of plant-based diets as intervention with cardiac health within the United States population. A database search of CINAHL Plus, MEDLINE, BIOSIS, Cochrane, Google Scholar, and PubMED was conducted and university librarians were utilized. Inclusive criteria and keyword searches were comprised of coronary artery disease and plant-based diets, cardiac disease and diet interventions, intensive lifestyle changes for reversal of coronary heart disease, plant-based diets and cardiac disease and inflammation, and plant-based diets reducing cardiac inflammation.

Aortic stiffness is an independent risk factor that has prognostic value regarding future cardiovascular disease (CVD) events such as myocardial infarction, strokes, and heart failure. Although death rates due to coronary heart disease have declined in recent years, the leading global killer remains CVD and prevalence is still high. Understanding lifestyle contributors associated with aortic stiffness would provide the public with insight into targeting key health-related behaviors. The purpose of this observational study was to examine the association of physical activity, physical function, and dietary quality as independent factors contributing to aortic stiffness in apparently healthy middle aged men. Fifty-two men between the ages of 30 and 59 years were recruited to participate in this study, which required two visits to the Exercise Physiology Laboratory. Aortic stiffness was measured by aortic pulse wave velocity (aPWV) and was not associated with total daily step counts (r=-0.06; P=0.70). However, aortic stiffness was inversely associated with physical function, determined with the sitting-rising test score (r=-0.44; P<0.01) and inversely associated with relative muscular strength, determined with peak handgrip strength in both hands normalized to body mass (r=-0.41; P<0.01). Additionally, aortic stiffness was inversely associated with dietary quality, determined with the Healthy Eating Index score (r=0.51; P<0.01). In conclusion, key health-related behaviors in this study that explained a large percentage of the variation in aortic stiffness were physical function and dietary quality (Adj r²=0.47; SEE=0.634). Hence, optimizing overall musculoskeletal fitness by focusing on strength, balance, coordination, and flexibility in addition to greater adherence to the U.S. Dietary Guidelines are key lifestyle contributors associated with reduced CVD risk in otherwise healthy middle aged men.

Individuals with intellectual and developmental disabilities (IDD) are prone to certain diseases in their lifetime, such as osteoporosis. Absorption of calcium is essential to maintaining good bone health and preventing osteoporosis. This study examined primary care providers’ (PCPs) choice of calcium supplementation, as well as type of calcium supplementation, and the relationship between variables in the IDD population. Ten PCPs were asked to complete a 14-question web-based survey, with five surveys completed. Calcium citrate was the preferred supplement among respondents at 50%. Retrospective data was collected from patient records and included type of calcium supplement prescribed, bone density test results, and other variable factors. The type of calcium supplement prescribed did not affect bone density results in subjects with IDD. There was a weak significance between calcium supplement type and gender and vitamin D. It is of modest benefit to include vitamin D with calcium supplementation to enhance calcium absorption.

Since 1980, the obesity rate in children 5 to 11 years of age has increased from 7% to 18%. The lack of structured physical activity and poor dietary habits childhood are primary risk factors for obesity related comorbidities in adulthood. Guided by primary care providers, families can reverse childhood obesity by implementing healthy dietary habits and engaging in structured physical activity. The purpose of this quality improvement project was to develop an evidenced-based policy with procedures to standardize the timely and consistent identification of overweight children at a primary care clinic serving military families. With an emphasis on obesity prevention within families through primary care interventions, the revised health belief model guided the project design. A literature review was conducted in a systematic manner to identify effective strategies and interventions to inform the policy development. Then, the Delphi technique guided a 12-member expert panel to evaluate the policy and procedures in terms of the level of evidence and the implementation plan with the goal of achieving consensus with recommendations for revisions. Consensus was achieved with multiple revisions following the completion of two Delphi rounds. The first panel session (n=12) concluded with a 70% consensus, including recommended revisions to improve the policy implementation. The second panel session (n=12) concluded with 100% consensus for the revised policy. The final policy and procedures addressed the clinical practice gap with a robust process to identify, counsel, and refer overweight children to external specialty programs for obesity management. By intervening to reverse the progression of childhood obesity, this project achieved positive social change at an organization level.

Improving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improving nutritional status. ONS use has been associated with improved outcomes among patients with diagnoses of orthopedic injuries and pressure ulcers, mainly using prospective designs among elderly and/or malnourished patients. Less information is available for other diagnoses, and no analysis of the effects of ONS could be found that considered the epidemiological triad of person, place, and time. This study used a quantitative, retrospective design to examine whether routine ONS use was associated with hospital length of stay (LOS) among 570 adult inpatients at a regional medical center diagnosed with heart failure, adjusting for significant personal, locational, and time variables. It was unique in the inclusion of epidemiological triad variables. Using multiple logistic regression to control for covariates, ONS use was associated with higher LOS in this sample (odds ratio=2.43). High LOS was also associated with higher Charlson Comorbidity Index (CCI) values, discharge destination, White ethnicity, female gender, and hospital room location. This study is expected to contribute to positive social change by helping inform hospital staff on factors affecting patient outcomes and LOS, and highlighting the need for continued research on interventions to improve care in hospitals.

Undocumented end stage renal disease (ESRD) patients in the United States only have access to emergency dialysis. To compensate for the lack of regular dialysis these patients must follow strict renal dietary restrictions. However, nutrition counseling by a dietitian is not part of the renal management of patients on emergency dialysis. The purpose of this quantitative quasi-experimental treatment-control study was to assess how the application of nutritional counseling that is both culturally and linguistically competent affects dialysis frequency and biochemical lab values such as serum potassium, phosphorus, and vitamin D of patients in emergency dialysis. The study was grounded on the social cognitive theory and consisted of a secondary data analysis of information collected from electronic medical records. The sample size consisted of 96 emergency dialysis patients, 51 from the intervention group, and 45 from the control group. Results from Quade's test revealed there is statistically significant difference in serum levels of phosphorus [F(1,94) = 9.616, p = 0.003] and levels of Vitamin D [F(1,94) = 51.411, p = .000] between the intervention and control groups, controlling for age, gender, and time on dialysis. These findings suggest the implementation of nutrition counseling that is both culturally and linguistically competent can improve phosphorous and vitamin D levels among emergency dialysis patients. The potential social change implication of this study is that its findings may serve to assist health care professionals to design and implement interventions to improve the health status of emergency dialysis patients and reduce their impact on the public health system.

The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of viral suppression, retention in care, and CD4 counts. The behavioral model for vulnerable populations was used as the theoretical foundation for this quantitative cross-sectional study. A sample of 428 RWHAP clients was used from the Ryan White Services Report data. Pearson's chi-square was used to examine the association between medical nutrition therapy (MNT) and viral suppression. Findings indicated statistically significant associations between MNT and viral suppression, retention in care and any nutrition service (food assistance, MNT, or both), and MNT and retention in care. Implications for social change include emphasizing the role of nutrition services in HIV-related health outcomes for PLWH in resource rich areas.

Due to increased rates of childhood obesity since 2010, researchers have examined family environmental factors and family influences on children's consumption of healthy foods. While previous research has examined how factors such as food presentation and the food intake of other family members can predict a child's body mass index, there has been little research examining whether parent factors predict the amount of healthy foods children eat. This quantitative survey study examined whether certain parent factors, specifically parents' attitudes about food, parents' feeding styles, and parents' attachment styles, predicted the amount of fruits and vegetables children ate. Understanding the extent to which these factors predict children's actual consumption of healthy foods, rather than predicting their body mass index, will further inform the healthcare field about parents' role in their children's physical development. Family systems theory served as the theoretical foundation. Seventy-four parents of children ages 1 to 7 years completed an online survey containing items from the Caregiver Feeding Styles Questionnaire, the Relationship Structures Attachment Questionnaire, and the Parent Attitudes About Food Questionnaire. As well, they logged the amount of fruits and vegetables their child ate over a 1-week period. The results of the multiple regression analysis revealed an overall significance which suggested that the 3 parent factors together predicted the amount of fruits and vegetables that children ate; however, closer examination indicated that only parents' attachment style was a significant prediction of children's consumption of fruits and vegetables. The results of the study add to our understanding of the role that parents play in their children's eating habits and the influence of attachment on children's consumption of a nutrient-dense diet.

In Ethiopia, 17% of pregnant women ages 18-49 are malnourished and have low awareness of prenatal nutrition, which may relate to increasingly high rates of maternal and infant mortality. The purpose of this mixed methods research study was to determine the effects of a community-based prenatal nutrition education intervention program on maternal nutrition knowledge and attitudes in the Alaje district of Ethiopia. The theoretical framework was Sen's capability theory of poverty, in which opportunities can lead to well-being and promote economic development. Research questions focused on the relationships among 8 independent variables-age, income source, degree of program implementation, marital status, education, number of pregnancies, number of children, and occupation-with respect to maternal nutrition knowledge and attitudes. Health workers recruited 135 pregnant and non-pregnant women in each of 2 villages: Dejen (control village) and Takha (experimental village), totaling 270 participants. The community intervention program was an add-on to the Ethiopian government's nutrition program and provided information on portion sizes, the importance of eating an extra meal each day, and obtaining adequate rest during pregnancy. Data from customized pretest and posttest focus groups and surveys were collected. Focus groups were analyzed manually and surveys were analyzed using 1-way ANOVAs and descriptive statistical analyses. The key findings were that the women in Takha had significantly greater knowledge of the importance of prenatal health requirements. The implications for positive social change include recommendations for policy makers about proper dietary practices in order to improve pregnancy outcomes related to maternal malnutrition.

This study was conducted to assess the effect of nutrition education utilizing computerized dietary analysis on nutrition knowledge, dietary compliance, nutrition status, and quality of life in hemodialysis patients. Twenty patients of the Bonneville Dialysis Center in Ogden, Utah voluntarily agreed to participate in this six-month study. All participants completed quality of life assessments, the Beck Depression Inventory© (BDI), and a nutrition knowledge assessment pre- and post-study. Patients in the treatment group (n=12) completed monthly 3-day food records which were analyzed by Computrition® nutrient analysis software. Results were discussed with the patients during one-on-one education sessions. Control patients (n=8) completed 3-day food records pre- and poststudy. Monitoring parameters included: nutrition-related laboratory data, kinetic modeling data, weights, and percent body fat, using Futrex® near infrared interactance. Dietary components followed were: protein, calories, sodium, potassium, calcium, and phosphorus. Multivariant analysis of variance was used for statistical comparisons. Weight and percent body fat were relatively stable throughout the study period for both groups. The treatment group's nutrition knowledge improved as measured by pre- and post-study test scores. Nutrient intakes showed no significant changes except for calorie intake, which decreased in the treatment group. The treatment group's intake of other analyzed nutrients showed declining trends, which were not statistically significant. Serum albumin and total protein increased in both groups. Average serum cholesterol levels decreased in the treatment group. Serum potassium levels did not change significantly. Serum phosphorus increased in the treatment group. However, this did not appear to be caused by increased dietary phosphorus intake. Kinetic modeling data showed a significant increase in protein catabolic rate of experimental subjects. Protein catabolic rates (PCR) are an indicator of dietary protein intakes in maintenance hemodialysis patients. The treatment group showed improvement in the alertness behavior area of the Sickness Impact Profile© (SIP). The control group declined in the recreation and pastimes area of the SIP. No significant changes were observed in the BDI. These results indicate that computerized dietary analysis is an effective instruction tool, is helpful in improving dietary protein intake as measured by PCR, and may contribute to improved quality of life of hemodialysis patients.