The Corral de Piedra community is located in Chiquimula, Guatemala. The main agricultural activities are corn and bean production, small-scale gardens, and small animal production, such as poultry and pigs. The crop areas are predominantly located on lands with slopes between 12 and 55%, presenting low fertility conditions and poor moisture retention capabilities. In addition, local crop varieties have low productivity potentials and the winter season is characterized by poorly distributed and erratic periods of rain. The Benson Institute introduced a technology transfer model to increase and diversify agricultural production, while preserving current natural resources. An integral part of this model included educating the community on nutrition and health topics. The school was considered to be the most appropriate place to introduce training and education in agriculture among students and community leaders, thus contributing to community development.

In many countries, the health and the development of a great number of people are compromised by the insufficient distribution of micro-nutrients. The deficiency of iron is one of the things that to a large extent contributes to the high rates of death and maternal and childhood mortality, affecting also a great percentage of school aged children. Bolivia, along with the majority of underdeveloped countries, presents high prevalence of anemia in the students. Recent studies confirm that anemia nutrients are a problem of public health of great magnitude to rural and urban level (Fernández et al, 1994). Before this situation the project to UNITE - UMSA through a diagnosis carried out in Viacha (Prov. Ingavi - La Paz) in 1996 on the eating situation and nutrition of families determined that the food sources of iron consumption dropped, for which one of the recommendations of said study was to carry out interventions such as to supplement and to fortify food with iron. In that context, the need to distribute a school breakfast constituted by a food (api or flour of purple corn) fortified with iron has been seen and to measure the effect that has the consumption of that food on the nutritional state of iron in the students. The api is a food that can be fortified with iron, apart from having a good contribution of energy, it is accessible economically to the population of the altiplano Bolivian and is preferred for the children. The distribution of the api fortified with iron would be able to reduce the prevalence of anemia in the students of the rural area. The present study, will measure the effect of the consumption of api fortified with iron on the iron deficiency anemia of the students of the rural area of the region altiplánica Irpa Small, province Ingavi of the department of La Paz.

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This research was conducted in an effort to substantiate the effect of nutrition counseling delivered at a local cholesterol screening clinic. It developed a method of measuring dietary habit changes conducive to a cholesterol- lowering diet. Hypercholesterolemic subjects were chosen for the study when their total blood cholesterol measured > 200 mg/dl from a Reflotron cholesterol screening device. At that time they were asked to fill out a dietary habit pre-test. Pre-tests from six subjects who did not receive nutrition counseling at the clinic were placed in the control group. Pre-tests from 15 subjects who received nutrition counseling at the clinic served as the test group. / Master of Science

This study investigated the influence of nutrition education services, measured by duration of participation and frequency of nutrition counseling, on maternal nutritional performance, and pregnancy outcome, in 100 pregnant teenagers enrolled in the WIC program in North Carolina. Data on prenatal weight gain, rate of weekly weight gain, gestational duration and birth weight of infants born to these teenagers was retrieved from medical records. Twenty-four hour recalls, conducted before and after counseling, were analyzed. for energy and nutrient content. Results indicated that initiation of prenatal care by trimester was earlier, and duration of participation was longer, than was reported in the literature. Mean weight gain and gestational lengths were found to be comparable to results from studies on similar populations. Rate of weekly gain was significantly higher than that recommended for adult pregnant women. Energy, protein and iron intakes showed significant improvement after counseling, and, were comparable to RDA values. However, calcium intake was found to be significantly lower than the RDA. Mean infant birth weight was found to be 47.2 gm heavier than the state average; this was not statistically significant. Although a strong correlation. between counseling and. pregnancy outcome was not evident, the incidence of low birth weight was substantially lower in this population, especially among the subgroup of black infants. A decreased incidence of poor outcome of pregnancy among underweight gravidas, was also indicative of the influence of nutrition education on this high risk group. Nutrition intervention appears to have been indirectly influential in optimizing fetal outcome through improved maternal weight gain, and an extended gestation. In addition, early and appropriate prenatal care measures, probably helped reduce the race specific, risk differential for adverse outcomes. The results from this study also indicated that a very small percentage of teens chose to breast feed. Further studies are, however, recommended to identify predictors of the feeding choice, to help increase incidence of breast feeding among teens. / Master of Science

Although the association between elevated serum cholesterol levels and cardiovascular risk has been known for many years, few studies, with freely living individuals have used a full complement of intervention strategies to attempt to alter practices associated with elevated serum cholesterol. Two studies, (Study 1, n=4; Study 2, n=8) with 12 middle age men (mean age = 47.3 years) and with elevated serum cholesterol (x= 238.7 mg/dl) are presented that use multiple measures of serum cholesterol (using the Boehringer Mannheim Reflotron and finger stick technique). The main intervention strategies included a combination of procedures using education, frequent serum cholesterol feedback (two to three times per week), and specific dietary feedback (one to two times per week). A less intensive intervention that is similar to recent studies in the literature was also implemented and assessed for half the subjects in Study The results of the two studies indicated that within approximately 14 weeks, the combination of enhanced procedures reduced serum cholesterol by about 14%, or about double that found in prior studies. The less intensive intervention showed reductions of 9.1% The use of multiple measures also allowed for the study of intraindividual variability. issues pertaining to maintenance of effect, cost-effectiveness, and generalizability are also discussed. / Master of Science

The purpose of this research was to explore patients' perceptions of services provided by hospital dietitians. The two-phase study included: (1) personal interviews of thirty-one patients to determine service attributes believed important when receiving a dietitian's service, and (2) development of a survey instrument, NUTRI-SERVE. Responses were obtained from 103 inpatients and 107 outpatients to identify service dimensions, differences in rating dimensions by patient group and gender, and relationships between dimensions, satisfaction, and recommendation of services. Results of personal interviews via qualitative analysis were used to develop NUTRI-SERVE. The survey format was a seven-point agreement scale. The instrument was reviewed for face validity and pilot tested. For the hospital survey, patients were randomly selected and surveyed by telephone; response was 87%. An a priori analysis approach was utilized examining dimensions with factor analysis to assess unidimensionality. Service dimensions: rationale, teach, motivate, care and consideration, reliability and responsiveness, and support staffphis outcome dimensions: learn and belief in the dietitian resulted. The factored scales demonstrated reliability. Outpatients rated service and outcome dimensions significantly more favorably than inpatients. Male outpatients rated and recommended the majority of services and outcomes significantly higher than female outpatients. The support staff dimension was rated highest by patients, while the teach dimension was rated lowest. The lowest rated outcome was learn. Inpatients and outpatients equally rated satisfaction with the dietitian's services favorably. Service and outcome dimensions were highly correlated. Motivate was the strongest driver for satisfaction and recommendation of services. Care and consideration was the strongest driver for motivate. Satisfaction with handouts was a driver for outpatient service dimensions, while satisfaction with the diet instruction room was a greater driver for inpatients. A customer service model was developed from these dimensions. This research provides insight into patients' perspective of service quality relating to hospital dietitians. It suggests satisfaction with dietetic education in an outpatient setting is strongly related to successfully learning the diet. This could be a useful management and marketing tool for dietetic managers, educators, and dietetic interns. Further research using NUTRI-SERVE is recommended to explore demographic and regional perceptions of service quality in dietetics. / Graduation date: 2003

Orientador: Rogério Lopes Vieites / Banca: Flávia Queiroga A. Almeida / Banca: Juliana Audi Giannoni / Resumo: Rótulo é toda e qualquer informação referente a um produto que esteja transcrita em sua embalagem. Para o consumidor é por meio das tabelas de informação nutricional contidas nos rótulos que se tem acesso a dados como quantidade e porcentagem dos nutrientes presentes nos alimentos. Através desse conhecimento, pode-se realizar escolhas alimentares mais saudáveis, mitigando os efeitos negativos referentes à má nutrição na população, principalmente entre as crianças, alvo mais crítico da incidência da obesidade. O presente trabalho buscou verificar se os aspectos gerais dos rótulos de alimentos consumidos pelo público infantil estavam em acordo com a legislação brasileira vigente. Foram analisados os rótulos de vinte e cinco produtos por meio da Ficha de Avaliação de Rotulagem, elaborada com base nas RDC N° 259 e N° 360. Analisou-se também a adequação nutricional dos nutrientes destes alimentos (carboidratos, proteínas, gordura total, gordura saturada, gordura trans, fibra alimentar e sódio) em relação à preconizada pela IDR para crianças de 4 a 8 anos de idade. Dentre os 181 rótulos avaliados, notou-se percentual de 36,2% de inadequações das informações obrigatórias, destacando-se a ocorrência de vocábulos induzindo ao equívoco o consumidor em 36,1% das embalagens e da não especificação, na lista de ingredientes, dos aditivos alimentares utilizados em 33,4% dos rótulos. Em alguns alimentos como empanados de frango e macarrões instantâneos, observou-se que com apenas uma porção já se atingia a totalidade das necessidades diárias infantis para o nutriente sódio. Constatou-se alto percentual de gorduras totais e saturadas em grande parte dos alimentos, assim como elevado índice de carboidratos e baixo teor de fibras alimentares. Desta forma, conclui-se que, apesar da legislação... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Label is every and any information regarding to a product that is transcribed in its package. Through this knowledge, it is possible to make healthier food choices, minimizing the negative effects related to poor nutrition in the population, especially among children, the most critical rate of obesity incidence. Labels of twenty-five products were analyzed hrough Labelling assessment form, drawn up on the basis of the RDC N° 259 and N° 360. The nutritional adequacy of the food's nutrients was also examined in relation of advocated by IDR to children from 4 to 8 years old. Among the 181 labels evaluated, the percentage of 36.2% for inadequacies from required information was noted, highlighting the occurrence of words inducing the misconception to consumer in 36.1% of packges and, in the ingredients list, the lack of specification for food additives used in 33.4% of labels. In certain foods such as breaded chicken and the noodles, it was noted that with only one portion the children's daily sodium nutrient needs are achieved. High percentage of total fat and saturated fat was found in the majority of the food, as well as high level of carbohydrates and low rate for dietary fiber. In this way, it is concluded that, in spite of the food labelling legislation be comprehensive and serve as an example to other countries, there is still the need for increased monitoring for compliance with established standards. In addition, because it is valuable for the nutritional education strategy, the labelling of foods should receive greater attention from companies, providing more reliable data so that consumers make healthy food choices / Mestre

Orientador: Roberto Carlos Burini / Banca: Erick Prado de Oliveira / Banca: Adriana Lúcia Mendes / Resumo: Introdução: O Diabetes Mellitus tipo 2 (DMT2) é emergente problema de saúde pública tanto no Brasil, quanto no mundo e está associado a componentes comportamentais os quais incluem a ingestão dietética, inatividade física e obesidade. A mudança do estilo de vida (MEV) pela prática de exercícios físicos e aconselhamento dietético mostra-se como terapia mais efetiva para o tratamento e a prevenção da alteração glicêmica e do DMT2. Objetivo: Verificar a eficiência de 20 semanas de programa para a mudança do estilo de vida sobre a glicemia de jejum. Métodos: Foram avaliados 237 participantes ingressantes no programa para mudança do estilo de vida (dieta e atividade física) mexa-se pró-saúde, no qual 121 completaram as 20 semanas de intervenção. Os pacientes foram avaliados quanto ao perfil bioquímico, avaliação antropométrica e nutricional, avaliação da aptidão física. Resultados: Houve reclassificação glicêmica de 27,28% dos participantes com alteração glicêmica, sendo 15,15% destes normalizados. O componente dietético variedade foi relacionado ao risco de 8% (estimativa de 0,0768 IC (0,0009-0,1527)) no aumento na glicemia e apresentando odds ratio de 1,079826 IC (1,0009-1,164975) para alterações glicêmicas. Conclusão: A baixa qualidade da dieta, principalmente pela baixa ingestão de grupos alimentares considerados protetores, influenciou a variedade alimentar como componente de risco nessa população, principalmente pela baixa ingestão qualitativa e quantitativa de cereais, frutas, hortaliças e fibras / Abstract: Introduction: Type 2 Diabetes Mellitus is an emerging public health problem in Brazil and worldwide and is associated with behavioral components including dietary intake, physical inactivity and obesity. The lifestyle change programs through the practice of physical exercises and dietary advice proves to be the most effective therapy for the treatment and prevention of T2DM and glucose amendment. Objective: Verify the efficacy of 20 weeks lifestyle change program on fasting glucose. Methods: We evaluated 237 free living people participating in the lifestyle change program (diet and physical activity) Mexa-se Pró-Saúde, in which 121 of the participants completed the 20 week intervention. Patients were evaluated for biochemical profiles, anthropometric and nutritional assessment, physical fitness assessment. Results: 27.28% of the participants some degree of glycemic change were reclassificated with 15,15% being normalized. The dietary component variety was related to a risk of 8 % ( CI estimate of 0.0768 ( 0.0009 to 0.1527 ) in the increase in blood glucose and presenting an odds ratio of IC 1.079826 ( 1.0009 to 1.164975 ) to glycemic alterations . Conclusion : The poor quality of the low diet mainly by low intake of food groups that are considered protective influence food variety as a risk component in this population mainly by low qualitative and quantitative intake of cereals , fruits, vegetables and fiber / Mestre