Thesis (M.A.)-- University of Texas Southwestern Medical Center at Dallas, 2006. / Vita. Bibliography: p. 158-163

Thesis (M.P.H.M.)--Mahidol University, 1999.

A desnutriÃÃo deve ser entendida como expressÃo de mÃltiplas dimensÃes, caracterizando uma sÃrie de situaÃÃes e condiÃÃes de vida bastante desfavorÃveis que atuam em um indivÃduo. O presente trabalho tem por objetivo compreender as percepÃÃes de mÃes de crianÃas desnutridas sobre sua realidade de vida, com base em um contexto socialmente desfavorecido, analisando, ao mesmo tempo, suas estratÃgias de enfrentamento diante das condiÃÃes de vulnerabilidade em que vivem, assim como suas impressÃes a respeito da instituiÃÃo onde seus filhos sÃo atendidos. A pesquisa realizou-se com sete mulheres, mÃes de crianÃas desnutridas, participantes do Instituto de PromoÃÃo da NutriÃÃo e do Desenvolvimento Humano â IPREDE, situado em Fortaleza, CearÃ, no perÃodo de maio a outubro de 2011. Adotou-se a metodologia qualitativa, desenvolvendo percursos etnogrÃficos, e o referencial teÃrico ancorado no campo interdisciplinar da SaÃde PÃblica. Fez-se uma discussÃo triangulada com origem na observaÃÃo sistemÃtica e participativa, entrevistas individuais semiestruturadas, busca documental, interpretaÃÃo da pesquisadora, com o auxilio do diÃrio de campo e diÃlogo constante com a literatura especializada. O material empÃrico obtido foi analisado conforme a tÃcnica de anÃlise de discurso. Foram realizados acompanhamentos da vida dessas mulheres no seu local de moradia, nas idas ao atendimento em Unidades de SaÃde e no IPREDE. Os resultados revelam forte associaÃÃo entre desnutriÃÃo infantil e dificuldades na maternidade e no vÃnculo entre mÃe e filho. As mulheres, marcadas pelas fragilidades e pela culpa, permanecem limitadas, fixadas nas preocupaÃÃes com a maternidade, nÃo vislumbrando saÃdas e oportunidades para viver melhor. Ante tantas privaÃÃes, constatou-se que as informantes buscam estratÃgias para enfrentar as adversidades, tanto no sentido emocional quanto cognitivo, procurando lidar com as situaÃÃes de estresse presentes em seu dia a dia. Buscam apoio na famÃlia, nos amigos ou nos vizinhos, trabalham, veem novelas, passeiam, dormem, rezam, procuram uma instituiÃÃode apoio, pensam positivo, mudam de companheiro, envolvem-se com um amante e procuram a justiÃa. No IPREDE, verificou-se a especial importÃncia atribuÃda pelas mÃes aos espaÃos de troca e relacionamentos mais democrÃticos com profissionais, pois elas podem se expressar e ser ouvidas em suas âdores da almaâ. Notou-se, tambÃm, a confianÃa no saber biomÃdico quando buscam orientaÃÃo e compreensÃo quanto à saÃde dos filhos. Tais espaÃos parecem ter contribuÃdo em seu crescimento pessoal, fortalecendo suas possibilidades de enfrentamento. SupÃe-se que programas de intervenÃÃo nutricional poderÃo obter resultados mais satisfatÃrios quando valorizada a histÃria de vida das mÃes como fator coadjuvante no processo de determinaÃÃo e recuperaÃÃo da desnutriÃÃo. O fato de compreender como essa mulher convive com o filho em seu habitat natural poderà fornecer subsÃdios sobre como cuidar melhor, caso a caso. O planejamento de atividades lÃdicas e com recursos audiovisuais pode promover situaÃÃes de aprendizagem mais relaxantes e participativas. Sugere-se, tambÃm, realizar consultas Ãs opiniÃes e preferÃncias das mÃes, o que pode estimular sua inclusÃo e autoafirmaÃÃo como sujeitos ativos em seu processo de cuidado e cura dos filhos. Entende-se que uma atenÃÃo psicoemocional mais individualizada e aprofundada à dÃade poderà favorecer o fortalecimento do vÃnculo mÃe e filho. / Malnutrition should be understood as a multi-dimensional expression characterizing a series of extremely unfavorable situations and living conditions that act upon an individual. To understand the perceptions of mothers of malnourished children regarding the realities of their lives, starting with a context of social disadvantage and at the same time analyzing theircoping strategies in the face of their precarious living conditions. In addition, their impressions of the institution where their children are cared for were also recorded. The study was conducted with seven women, mothers of malnourished children cared for at the Institute for the Promotion of Nutrition and Human Development - IPREDE, located in Fortaleza, CearÃ, between May and October 2011. A qualitative methodology was adopted, developing ethnographic accounts, and the theoretical framework was grounded in the interdisciplinary field of Public Health. A triangulated discussion was carried out using systematic and participatory observation of semi-structured individual interviews, document research and interpretation by the researcher, with the aid of a field diary and constant reference to the specialized literature. The empirical material obtained was analyzed using the technique of discourse analysis. The researcher monitored the lives of these women in their place of residence, visits to health care centers and IPREDE. The results reveal a strong link between child malnutrition and difficulties in the construction of motherhood and bonding between mother and child. The women, marked by fragility and guilt remain limited, fixed on concerns about motherhood; unable to see a way out or opportunities to live better. Faced with so many hardships, the subjects try to seek strategies to deal with adversity, in both the cognitive and the emotional sense, trying to cope with the stressful situations present in their day-to-day. They look for support from their family, friends or neighbors. They work, watch soap operas, walk, sleep, pray, seek a supportive institution, think positively, change partner, get involved with a lover and seek justice. At IPREDE, the mothers place particular importance on having a space for exchanges and more democratic relationships with professionals, where they can express themselves and share their "heartaches." Their confidence in biomedical knowledge when seeking guidance and understanding about their childrenâs health was also observed.These spaces appear to have contributed to their personal growth; strengthening their chances of coping. It is concluded that nutritional intervention programs can obtain better results when the life story of the mothers is valued as a supporting factor in the process of determining and recovering from malnutrition. Understanding how a woman lives with her child in their natural environment may provide insights on a case by case basis. The planning of pleasant activities and audio-visual resources can promote more relaxed and participatory learning situations. It is also suggested that the motherâs opinions and preferences be consulted, as this may stimulate their inclusion and self-affirmation as active subjects in their childâs care and healing. Deeper and more individualized psycho-emotional care and attention to the dyad,may favor the strengthening of the mother-child bond.

Master of Public Health - MPH / The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen. / South Africa

Two experiments were undertaken to evaluate the baby pig as a biomedical model with which to study Protein-Calorie malnutrition. In the first experiment, 32Yorkshire and Yorkshire X Landrace pigs weaned at 21 days were fed either an 18% or 4% protein ration. Blood samples were taken biweekly from the anterior vena cava and the serum samples analyzed for calcium, phosphorus, glucose, cholesterol, lactic dehydrogenase, glutamic oxaloacetic transaminase, amylase, a 1ka1ine phosphatase, total protein, albumin and blood urea nitrogen. Significant (p ≤.01) treatment effects were observed for total protein, albumin, amylase, alkaline phosphatase, lactic dehydrogenase, cholesterol, calcium and phosphorus. In the second experiment, 40 Yorkshire and Yorkshire X Landrace pigs weaned at 28 days were fed rations containing 18%, 10%, 8%, 6%, and 4% protein. Blood samples were again taken biweekly and serum samples were analyzed for the same parameters as in trial one. In addition, serum copper, iron, magnesium, and zinc were measured. The livers of any animals which died on the low protein diets, were fat extracted, and the level of fat compared to that obtained from livers of animals killed as suckling pigs at a slaughter plant. Total body water was determined on three animals on the 18% ration and three on the h% ration utilizing tritiated water as a tracer. Total protein, albumin, amylase, lactic dehydrogenase, calcium, phosphorus, copper, iron and magnesium correlated well with dietary protein intake. Significant treatment effects were observed for total body water and fat content of the liver. An attempt was made to find a biochemical parameter which might be used in diagnosing developing protein calorie malnutrition. The results of the study would indicate that serum phosphate and amylase are the most sensitive parameters to dietary protein intake. Not every lesion or biochemical serum change occurring in man was reproduced in the present study. Nevertheless, characteristic symptoms such as the development of fatty liver, growth retardation, abnormal hair texture, hypoalbuminemia, and apathy were reproduced in the protein deficient swine. The baby pig would therefore appear to be a good model for the study of protein-calorie malnutrition. / Land and Food Systems, Faculty of / Graduate

Introduction: Oxidative stress is a disruption in the balance of free radicals and antioxidants. Cancer patients have very high levels of oxidative stress due to radiation and chemotherapy. This imbalance from the oxidative stress can stimulate cancerous growth, as well abnormal cellular growth. Oxidative stress is due, in part, to lipid per-oxidation from cancer treatments, generating electrophilic aldehydes that attack abnormal, as well as healthy cells. A way to combat the amount of oxidative stress to protect healthy cells is to increase antioxidant defenses through the diet. Antioxidants are chemicals that help stop free radical formation and prevent cell damage. Traditional high antioxidant foods include fruits, vegetables, low saturated- fats, and high fiber foods. During cancer treatments the patient generally has a decreased sense of appetite, as nausea and emesis are common side effects. A “treat” food, like a Reese’s peanut butter cup might be able to stimulate a cancer patient’s appetite, and thus meeting some of their much-needed dietary nutrients. By transforming this popular dessert treat into something that could aid with oxidative stress may be beneficial to this population. The objective of this study was to create an appetizing and nutritionally functional Reese’s peanut butter cup alternative with enhanced antioxidants. Methods: A common Reese’s cup recipe was taken and adapted for more nutrient rich ingredients. The milk chocolate of the original control recipe for Reese's cup was substituted in the variant dessert cup with dark chocolate cacao nibs. The peanut butter was replaced by tahini, and the sugar was replaced by dates in the control and variant, respectively. Proximate analyses for the nutritional content of both dessert cups was collected. Analyses included: Total cal/g using bomb calorimetry, antioxidant potential by a ferric reducing ability of plasma (FRAP), Soxhlet for lipid determination, kjeldahl for protein determination, and fiber via a ANKOM Fiber Analyzer. Results: Calories for the control yielded 5961 cal/g, and the variant, 6007.5 cal/g. The absorbance data for FRAP was 2.9996 and 4.5426, for the control and variant respectively. Lipid content was 46.65% for the control (% Ether Extract (Crude Fat)) and 46.9% for the variant (% Ether Extract (Crude Fat)). Protein content for the control was 6.25%, and 9.65% for the variant. Analysis for dietary fiber found insoluble dietary fiber to be 26.6% and soluble dietary fiber 0% for the control. The variant’s insoluble dietary fiber content was 21.4% and soluble dietary fiber 8.7%. Finally, dry matter was 98.6% for the control, and 97.4% for the variant. Conclusion: Data collected showed the greatest differences between antioxidants, fiber, and protein, with the variant having the highest percent content of each nutrient. This research has shown that a dessert alternative can support patients undergoing cancer therapies through the provision of necessary calories and antioxidants. Future research is needed to compare the specific fatty acid content of these two products

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Hypotheses explaining maternal compliance behavior in relation to maternal attitudes and motivations and family and social influences were explored retrospectively in families of 39 obese infants from six to twelve months of age. Maternal social support and infant characteristics were not strongly associated or predictive of maternal compliance behavior. Stressful life changes in the family were negatively associated with maternal compliance to the dietary regimen. Maternal perception of infant fatness was negatively associated with dietary compliance behavior and positively associated with study protocol compliance behavior. Demographic variables were positively associated with compliance to study protocol. Family stress, maternal health beliefs, and demographic variables outweighed social support in their power to predict compliance behaviors. Compliance to study requirements did not necessarily mean compliance to the dietary regimen. Clinical use of assessing family stress, maternal beliefs and demographic variables appears to provide additional understanding of compliance behaviors in mothers with infant feeding recommendations.

Dissertation submitted in fulfilment of the requirements for the Degree of Magister Technologiae: Consumer Science Food and Nutrition, Durban University of Technology, 2011. / The objective of the study was to conduct a situational analysis of elderly people on state pension living in Umlazi, KwaZulu-Natal South Africa. The research focused on the socioeconomic status, dietary intake, nutritional status, and health status of this community. Methodology The sample comprised 270 (224 women and 46 men) randomly selected elderly people within the 12 wards of Umlazi. The methods used for assessment included a sociodemographic questionnaire which determined the socioeconomic status. A 24-hr recall questionnaire and food frequency questionnaire were used to determine dietary intake, while anthropometric measurements were conducted to determine the nutritional status. A health questionnaire, including a salt administration questionnaire was used to determine the health status of the elderly in this community. Trained field workers and nurses assisted in data collection and food consumption data was captured and analysed by a qualified dietician using Food Finder version 3.0 computer software program. Descriptive statistics (frequencies, means, standard deviations and confidence intervals) were determined with the assistance of a bio-statistician. Socio-demographic and health data were captured onto an Excel(R) spreadsheet by the researcher. These questionnaires were analysed using the Statistical Package for Social Sciences (SPSS) for Windows version 17, 0 software program. Results The majority of respondents lived in brick houses (84.8%) and the living space generally consisted of more than three rooms (87.4%). However, the majority of respondents who lived with >4 to 10 members were 67.4% whilst only 32.6% of households consisted of less than 4 members. The mean household size was 5.1 (±SD 2.9) people, this further illustrates that the majority of respondents lived with 5 people per household. Grandchildren were present in 70% of the households with a mean of 3 (±SD 5) grandchildren in each household. Results also indicate that 84.6% of the elderly were the bread winners in these households. The vast majority of 87.8% of the population had no other source of income. The majority of vi Pagevi respondents with an income had a total monthly income of R500- R1500 (82.9%) followed by R1501- R2500 (14.1%) and only 3% had more than R2500 total income. Food expenditure for most (80%) households was >R500 of the total income. Food shortages due to limited income were frequent in 54% of households who regularly experienced this problem, whilst 26% sometimes experienced shortages, 15.4% often encounted shortages whereas 2.6% encounted shortages seldomly and 2.2% never. A large majority of respondents owned electrical assets, the most commonly owned included a televison (80.3%) , a radio (75.5%) and a refrigerator (75.1). The majority of food items consumed were carbohydrate based and the portion sizes were relatively big, on average 1348.5g per day. The energy contribution from carbohydrates was 65% which is considered to be on the high side (WHO goals 55-75%). Protein intake was fairly common, with a 15% contribution to energy from total protein (WHO goals 10-15%). The frequency of vegetable and fruit intake was very low, the portion sizes were also small and did not meet the recommended daily intake. The energy contributions showed that 89.2% of the women consumed a diet that supplied <100% of Estimated Energy Requirements (EERs) and all the men consumed <100% of the EERs for energy. Sixty three percent of the women and 91.1% of the men consumed <100% of the EARs for protein. The mean carbohydrate intake in the sample was significantly higher than the EAR but the women consumed <100% of the EARs for carbohydrates (4.1%) and all men consumed >100% of the EARs. The majority of the vitamins for both genders indicated low intakes except for vitamin B12 and B6 in the case of men only. The majority of minerals indicated low scores for micronutrients except for iron (36.6% for men) and potassium (39.0% for men) which was consumed mostly by men than women. The mean Food Variety Score (FVS) (±SD) for all the foods consumed from all the food groups in a period of seven days was 25.8 (±14.6). The results revealed poor dietary diversity scoring. The cereal group had the highest mean variety score 5.3 (±2.5) followed by vegetables 4.5 (±2.6), fruit 3.5 (±3.1), flesh foods 3.2 (±1.6), vitamin A-rich fruit and the vegetable group 3.1 (±1.7). The anthropometric indices indicated that the mean age was 69.7 years (±SD 7.1) and mean weight of 76.5 kg (±SD 17.3). The BMI scores for the total group indicated that 52% of the respondents fell into the obese category (BMI = obese 1 >30, obese 2 >35 and obese 3> 40) and 24% of the respondents were overweight (BMI = 25-29.9). Only 20% were of moderate weight (BMI 18.5- 24.9). Although more men were overweight (34.2%) compared to 21.9% vii Pagevii of women, more women (60.1%) were obese compared to men (18.8%). The majority (83%) of the women were above the cut-off points for waist circumference ( 88cm) and 17% were within the normal values whilst 74% of the men were within recommended cut-off points ( 102cm) and only 26% exceeded the recommended scores. The results indicate that 77% of respondents were at risk of developing metabolic syndrome exceeding >0.5 waist-to-heightratio (WHTR) and 23% were at lower risk. However, the women showed a higher risk of 87.4% and men only 47.9% for metabolic risk. The correlation was significant at the p=0.01 level. There was thus as highly significant relationship between BMI and WHTR ratio for women. The health survey results indicated that 90% of the elderly population were in various stages of hypertension and 6% showed signs of developing hypertension. However, hypertension was more prevelant in women (91%) than in the men (83%). There was a statistical significant correlation (p=0.01) between waist circumference and systolic pressure for both women and men. A high percentage (82%) of the participants reported that they were currently on chronic medication whereas 18% were not using any chronic medication at the time. Although hypertension was prevalent in most respondents, it was followed by self reported diabetes (26.7%) and cancer (1.9%). Results show that elderly experienced problems with following ereas in the body skeletal joints (72.6%) as well as eyes and teeth were problematic in 75.9% of the respondents, followed by skin problems (29.6%) and ears and nose problems (28.6%). Results in the salt administrative questionnaire indicate that sodium intakes were below WHO goals <2000mg. Results also show that a high percentage of respondents (60%) generally never added salt to cooked food as the majority saw it as a health risk. Only 13% added it always to cooked food and 21% added it sometimes. Conclusions The results in the study indicate the high prevelance of poverty, food insecurity and poor nutritional and health status that compromises the quality of life of elderly living in this community. Recommendations Long-term intervention studies must be prioritised to address economic, health, social and demographic factors and future research is needed to cater for the growing needs of this population group.