Studies have shown that many low-income and disadvantaged Americans have a poor diet quality, which increases obesity and chronic disease risk. According to the Massachusetts Department of Public Health, education and income levels of Springfield residents are well below state averages, and racial diversity in Springfield has increased significantly over the past few decades. Springfield’s demographics increase the risk of health disparities in the community, and higher rates of diabetes, heart disease, and obesity are seen in Springfield. To promote healthy eating behaviors among Springfield residents, Mason Square Health Task Force (MSHTF), a Live Well Springfield (LWS) partner, created a 6-session nutrition curriculum, entitled The MENU Program. The goal was to increase overall health awareness and healthy eating behaviors among residents in communities that are being targeted by the LWS initiative. Topics of the The MENU Program included MyPlate guidelines and label reading, budget shopping and cooking, healthy restaurant choices, diet and chronic disease, and food justice. The objective of this study was to evaluate The MENU Program to assess its strengths, weaknesses, and effectiveness using both quantitative and qualitative data from surveys, process evaluation, and facilitator observations. There were two phases of this study: Phase 1 was the evaluation of the pilot program delivered to a group of senior women recruited through the Dunbar YMCA; Phase 2 evaluated the second offering of the curriculum to Mason Square residents enrolled in the Task Force Fit Challenge. All participants responded positively to The MENU Program sessions and positive changes were seen in knowledge, attitudes, and behaviors after both Phases. Participant-perceived useful material included handouts, group discussions, and hands-on activities. Observational data supports the usefulness of group discussion over lecture-based teaching methods. This study supports the use of The MENU Program as an effective community education program for Springfield, MA. It has the potential to positively influence residents’ diet quality and nutrition-related behaviors through improved nutrition knowledge and attitudes.

High fruit and vegetable (FV) intake is associated with healthy weights and decreased risk of chronic disease. Yet, adolescent FV intakes fall below national recommendations. Few studies involve racial/ethnic minority adolescents in formative research, despite their increased risk of poor FV intake. Consequently, the purpose of this study was to describe the type and frequency of FV intake of urban multicultural young adolescents, and to examine their attitudes and beliefs towards increased consumption of FV. A convenience sample (n=79) of racially diverse (e.g., 31% Hispanic/Latino, 27.4% Black/African American) grade seven students, participated in our study comprised of a self-administered survey with culturally adapted FV food frequency questionnaire (FVFFQ) and focus group discussions. The FVFFQ revealed that hand fruit was the most highly consumed fruit among our students, while consumption of vegetables was more evenly distributed. Preferred FV among racial/ethnic population groups ranged with Hispanic/Latino identifying citrus, leafy green vegetables preferred by Black/African American, tropical fruit by Asian and Whites reporting cooked vegetables. Availability of preferred vegetables as school significantly influenced vegetable intake (p=0.038). Family attitudes towards vegetables also influenced student FV behaviors (diet diversity (DD) score, p=0.008; FV self-efficacy scores, p=0.019). The median DD score (73%) indicated moderate compliance with national FV intake recommendations among students with red, orange, and ‘other’ vegetables requiring the most improvement in intake. Focus group discussions revealed important barriers to FV intake, including a preference for consuming ‘junk food’ for snacks over FV, a lack of availability of preferred vegetables at school, and parental financial constraints, which limited availability of preferred produce at homes. Students’ suggested strategies to motivate increased FV intake included greater incentives and modeling from parents, improved recipes and taste tests for vegetables served at school and greater availability of culturally diverse produce represented in school menu. Students emphasized social media for FV promotion targeted at adolescents. Overall, our findings suggest young adolescents are open to increased FV intake, but require a supportive home and school environment, with access to cultural and preferred produce; students indicated a keen interest in involvement with FV promotion initiatives undertaken in their school.

The nutritional status of children is declining as evidenced by the steady rise in childhood obesity rates over the last three decades. Consuming five servings of fruit and vegetables (FV) daily has shown to help with weight maintenance, but children are consuming far less than the recommended servings. This study was designed to test the efficacy of a sensory-focused multi-component school-based program at increasing vegetable intake among fifth-graders. Classroom, family, and community components allowed children to explore thirteen target vegetables with their senses including taste. Vegetable consumption was measured by digitalized observations of lunchtime vegetable selection and consumption. Vegetable acceptance was evaluated using a selfadministered survey assessing attitude and behaviors related to vegetable consumption. Measures were assessed at multiple time points and compared between the intervention school and a comparison school matched for demographic similarities. Parental consent was obtained for 136 fifth-graders to participate in the multicomponent study and 114 were included in the plate waste study. Data were collected over six days of plate waste observations including two phases: the control phase (CP) and the target vegetable phase (TVP) where target vegetables were served in addition to the regular lunch vegetables. Differences in mean vegetables taken and consumed during each phase of the plate waste study were analyzed using analysis of variance (ANOVA) and paired sample t-tests. When fried potatoes were included as a vegetable in the analysis, the comparison school took (P < 0.001) and consumed (P < 0.001) significantly more vegetables than the intervention school. There were no significant differences in vegetables taken (P < 0.258) and consumed (P < 0.217) when fried potatoes were excluded. Self-administered surveys were analyzed using the Fisher’s exact test and ANOVA. Significantly more children at the intervention school compared to the comparison school reported ever eating bell peppers, butternut squash, and cucumbers. The findings of this study do not show significant differences in vegetable consumption when the intervention school is compared to the comparison school, but do show a small trend toward increased acceptance of target vegetables. Future studies should evaluate a larger sample size with increased frequency of taste testing opportunities.

Subclinical vitamin A deficiency was assessed in 65 Hispanic children attending four migrant Head Start programs in Utah. Subjects aged 2 to 6 years (median 3 years 10 months) were examined for evidence of vitamin A deficiency by conjunctival impression cytology. Biochemical indices for serum vitamin A, retinol-binding protein, zinc, and iron were performed. Of eight children (12.5%) with subclinical vitamin A deficiency, one child had a marginal serum vitamin A of 11 μg/dl. Retinol-binding protein concentrations were significantly lower in two subjects with abnormal conjunctival impression cytology. Serum zinc, which when low can mimic signs of ocular vitamin A lesions, was normal for all 65 subjects. Fifteen children (23%) had iron-deficiency anemia. Logistic regression was the central method of analysis used in this study. The results of the statistical analyses indicated there was a correlation value (0.31) between abnormal conjunctival impression cytology and serum vitamin A, which supports the hypothesis that abnormal conjunctiva! impression cytology is concurrent with decreased serum vitamin A. Assessment of vitamin A status of Hispanic migrant children by impression cytology was effective in identifying children at risk for hypovitaminosis A. Beyond vitamin A's role in vision and maintenance of epithelium, it is also required for growth and hematopoiesis. The children of migrant workers may be suffering physiologically important consequences of vitamin A and iron deficiency that can be prevented by screening with biochemical and histological testing. Nutrition intervention for deficient children is warranted.

Children's energy consumption is outweighing their energy expenditure, increasing the risk for childhood obesity. While pediatric obesity continues to be a problem in America, the data are clear that those of low socioeconomic status are especially at risk for weight gain. The purpose of this study was to evaluate if a healthy lifestyle program could affect participants' diet and physical activity behavior. A program was planned and conducted using the curriculum from the "We Can" program established by the National Heart, Lung, and Blood Institute. Residents of the Jefferson City Housing Authority were asked to participate. No resident attended or completed the healthy lifestyle program. Follow-up focus groups with stakeholders and potential participants showed that lack of motivation was the greatest barrier to participation. Further investigation is needed to determine a more suitable venue to educate at-risk populations regarding the risk associated with pediatric obesity.

Background: Malnutrition can affect the body composition changes that occur in healthy pregnancy, resulting in adverse effects to both the mother and infant. Supplementary foods with high quality protein may result in more favorable changes in lean mass and fat mass in pregnant malnourished women. Objective: To retrospectively assess changes in body composition in moderately malnourished pregnant Malawian women in response to one of three nutritional interventions. Methods: Height, weight, MUAC, and TSF were measured in pregnant women with MUAC >20.6 cm and19) were compared using ANOVA. If differences were detected, differences between groups were tested using the Tukey HSD test (continuous) or Chi-squared test (categorical). Longitudinal changes were also measured using mixed model analysis of variance. Results: At baseline, women had small MUACs and low fat stores, but high muscle mass. Overall, women had significantly larger MUACs at the end of follow up than at baseline, except in adolescents in CSB-IFA and CSB-UNIMMAP. Women overall had significantly larger AMA at the end of enrollment than at baseline, with mature women in the RUSF group experiencing the largest increase compared to adolescents in RUSF and all women in CSB-UNIMMAP and CSB-IFA. On average, AMA was between the 50th-75th percentiles compared to women in the western world, indicating maintenance of muscle mass despite moderate malnutrition. TSF and AFA were both low in all age groups, falling below the 5th percentile for mature women and below the 10th percentile in adolescents compared to women in the Western world. There was no difference in birth weight across intervention groups. Among births that occurred during the rainy season, every cm of MUAC at the end of enrollment resulted in a 0.29 cm greater birth length. Conclusions: Overall, women improved their nutritional status but did not recover from moderate malnutrition over the course of enrollment. MUAC and BMI were the strongest predictors of birth weight, highlighting the contribution of overall nutritional status to birth outcomes. Women had high muscle mass relative to fat stores, with women in the RUSF group experiencing the largest accrual in muscle. More accurate and objective methods to measure body composition could provide greater detail about changes in body composition over the course of pregnancy in response to supplementary foods.

The study conducted in the rural area of the province of Imbabura included a total of 518 families that when compared with the estimated sample of 96%, 42.7 % corresponding to the indigenous ethnic group, 28.15% to Black and 25% to mixed-race ethnic groups, these differences of involvement between ethnic groups is due to the fact that the indigenous population is greater than the two remaining populations. Of the 518 families studied they were able to obtain a total of 794 children younger than 5, in which 48.5% pertaining to the male sex and 51.4% to the female sex. In linking the number of participating families and the number of children studied we were able to find that mothers have 1 to 2 children younger than the age of 5 in every family. In evaluating the nutritional state of the 794 studied children, 47.09% were found to have global malnutrition (P/E), 67.26% presented a chronic malnutrition that is to say a lower height for their age, whereas 13.97% presented an acute malnutrition, a percentage that doesn’t attract attention due to what I have already noted previously with children presenting low height and weight for their age when using the indicated weight/height, the nutritional state of the children is appropriate. The nutritional state of children under the age of 5, by considering the indicators of weight/age and height/age, identified the indigenous ethnicity having major problems of malnutrition (54% and 80.97%) respectively, while the two remaining ethnic groups have presented similar percentages. The opposite occurs with the indicator of weight/height, which detected that the Black ethnic group presented a major nutritional deterioration (24%) unlike the other two ethnic groups, we believe that this difference is due to indigenous children presenting a diminished height, consequently when we use the indicator of weight/height, an adequate weight for height is presented. According to the magnitude of diarrheal processes we find that 28.34% of children presented EDA, the indigenous ethnicity being that with the highest percentage (12.84%) in relation to the other two ethnic groups. According to the severity of the diarrheal processes, light EDA presents the highest percentage with 62.67%, with the indigenous ethnicity being affected the most, moderate EDA presents a 34.22% similarly affecting the indigenous ethnicity and severe EDA presents a 3.11% with the mixed-race ethnicity being the most affected. Relating the nutritional state with acute diarrheal illnesses, considering the indicators of weight/age and height/age, we find that the indigenous population is mostly affected in nutritional state as well as in the presence of EDA. Malnourished children present a higher number of diarrheal processes. Considering the indicator of weight/height, diarrhea is more frequent in children with a normal nutritional state, with the Black ethnicity that which presents the greater percentage of EDA in normal and malnourished children. For this reason, it is urgent that national programs of health and alimentation are defined and implemented in order to combat the nutritional problem and ensure an adequate supply of food for the whole population, improving the conditions of health and environmental sanitation in order to reduce the high rates of malnutrition, diarrhea and acute respiratory infections.

Childhood obesity has tripled over the past three decades and poses a serious public health problem. The Smarter Lunchrooms Movement aims to increase healthy eating by incorporating low-cost to no-cost alterations to the school lunchroom in an effort to increase consumption of healthier foods, such as fruits and vegetables, by making them more attractive and convenient. Our study implemented Smarter Lunchrooms interventions at two primarily Hispanic elementary schools in Paso Robles, CA. The interventions focused on increasing the appeal of the salad bars, including installation of age-appropriate signage highlighting fruits and vegetables, as well as branding of fruits and vegetables with fun age-appropriate characters. Fruits were also placed into decorative bowls to increase their attractiveness. To determine whether these changes had an influence on fruit and vegetable choice and consumption, we tracked student’s choice and intake prior to and following the intervention. Consumption was analyzed using a visual tray waste measurement to determine how much fruit, vegetable, and entrée the students ate during lunch. Following the intervention, the proportion of children who selected fruits and vegetables increased at one school, but not at the other. Of the children that selected fruits and/or vegetables, the proportion eating the entire fruit or vegetable increased at both schools, while the proportion of students who did not eat any of their vegetables decreased at one school. There were few significant differences by grade level (1-3 and 4-5). If easy-to-implement strategies such as Smarter Lunchrooms interventions are effective mitigators of obesity risk, larger scale efforts across populations may help stem the ever-increasing impact of obesity. Therefore, future research should identify targeted methods by which to approach younger vs. older children among diverse socio-demographic and geographic groups.

The epidemic of adolescent obesity has become one of the greatest public health concerns in the United States. Approximately 20.5% of adolescents of both sexes aged 12-19 years are considered obese. Higher rates of obesity are evident in ethnic minority and lower income status children with the highest prevalence among Hispanic/Latino and Black populations. The causes for obesity are multifactorial in nature and highlight disparities nationwide. These factors include socioeconomic status, education, environment, availability and access to fresh fruits and vegetables, and behavior patterns. Successful intervention methods that have reduced the impact of adolescent obesity have incorporated nutrition knowledge and culinary skill building into afterschool programs. Pink and Dude Chefs, a 12-lesson nutrition education and culinary skills afterschool program targeted toward middle school students, aims to improve nutrition knowledge and dietary behavior in low income and minority populations. Based off of evidence-based curriculum, the program focuses on culinary fundamentals while incorporating nutrition lessons about macronutrients, micronutrients, label reading, kitchen safety, and USDA guidelines. Research assistants from California Polytechnic State University, San Luis Obispo and Vanderbilt University in Tennessee, were trained to implement each lesson. The program took place at Mesa Middle School in Arroyo Grande, CA; Shandon, CA; and two sites in Nashville, TN from Spring 2014 to Fall 2014. Thirty-two middle school students participated in the study aged 11-14 years. Questionnaires were used to measure fruit and vegetables preferences, nutrition knowledge, and fruit and vegetable intake. Results indicate that participants’ fruit and vegetable preferences, nutrition knowledge and fruit and vegetable intake all increased. However, statistical significance was only achieved with nutrition knowledge, likely due to small sample size. If programs such as Pink and Dude Chefs show promise for decreasing risk for obesity, the public health impact could improve long-term health outcomes for adolescents and mitigate obesity related consequences.

In the U.S., obesity has hit alarming rates and affects Hispanic children disproportionately. Acculturation, the shift from one culture’s values, beliefs and practices to those of a new culture, may have both negative and positive health effects on immigrants. The objectives of this study were to determine the association between the level of acculturation (low acculturation or high acculturation) of low-income Latina mothers and the foods consumed by their children (0 to 36 months old). The association between acculturation and maternal perceptions of infant and toddler body size, maternal perceptions of her own body size and maternal parenting stress were also investigated. This was accomplished in 3 stages. First, data was collected cross-sectionally from 68 participants of WIC. Mothers answered many questionnaires including Food Frequency Questionnaires for their children, body size perception scale questionnaires and a parenting stress test. General linear regression models were performed to investigate an association between acculturation and food frequency, maternal perceptions of body size and parenting stress. Each model controlled for child’s age, maternal age, BMI (m/kg2) and education level. Second, key informant interviews were conducted with nine public health professionals to help gain a better understanding of some of our findings and to develop questions for the third stage: focus groups. Third, a total of 32 mothers participated in focus groups to discuss their perceptions on acculturation and child-feeding habits, and children’s body size. In addition, three mothers completed one-on-one interviews. From the cross-sectional analysis of the first study stage, the level of acculturation did not have a significant effect on any of the factors measured. For all mothers, however an increase in child’s age was associated with an increase in both the amount of healthy foods and less healthy foods consumed; an increase in mother’s BMI was associated with an increase in the children’s consumption of less healthy foods (beta coefficient of -0.042; p = 0.035). An increase in child’s age was associated with an increased likelihood of a mother to correctly estimate her own body size (beta coefficient of 0.041; p = 0.043). An increase in maternal BMI was associated with an increased likelihood to underestimate her own weight as well as that of her child. During the second stage, a theme emerged from the focus groups that the mothers try to feed the children the way they were fed growing up but they encounter difficulties when they can’t find the same ingredients and when their children start to prefer American foods. For all groups health was the number one factor they considered when choosing what to feed their children. The low acculturated mothers stated they wanted more education on how to assess if their child is at a healthy weight and admitted to not thinking about weight very much. In both groups, the mothers reported getting information about their child’s weight from health care professionals but many mothers from the bi acculturated group mentioned not believing the doctor when they told them their child was overweight. Overall, the findings suggest that children’s diets are not different by mother’s acculturation level and that the children start to prefer American foods from a young age. Parental education for several areas were identified: 1) for mothers to learn how to continue with the healthful aspects of a traditional diet 2) teach parents about appropriate stages of growth for their children; 3) when trying to teach about food focus on other areas of health rather than weight since weight does not seem to resonate as a concern.