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Background: Cystic fibrosis (CF) is a genetically inherited disease which adversely affects the respiratory and gastrointestinal systems. Malnutrition is a major clinical problem in individuals with the disease. Nutritional interventions are warranted as improvements in nutritional status could improve the rates of morbidity and mortality associated with the disease. The review of the literature indicated the need to develop a behavioural-based nutrition prevention program in order for children to achieve CF dietary requirements and appropriate pancreatic enzyme replacement therapy.Methods: The intervention program, Go and Grow with CF, and nutrition and pancreatic enzyme knowledge and self-management questionnaires were developed for children with CF and their carers as part of this thesis. Social learning theory constructs which particularly assist children in achieving desirable behaviours were applied during the development of the Go and Grow with CF program. The program consisted of workshops and a home-based course.Fifty eight children with cystic fibrosis, aged 2 to 11 years, and their carers participated in a clinical trial that was designed to assess the effects of the Go and Grow with CF pilot program on knowledge, self-management, behaviour, dietary intake and body composition, using anthropometry. Process evaluation was conducted on the pilot program and on the clinic-wide implementation of the revised Go and Grow with CF program. The revised program included the Australian Pancreatic Enzyme Replacement Therapy Guidelines and the effects of fat-based dosing were assessed with a cohort of 29 children with CF-related pancreatic insufficiency aged 1 to 13 years.Results: Similar to the process evaluation of the pilot program, 100% of carers who completed the revised home-based course indicated that they would recommend Go and Grow with CF to other families ++ / with a child who has CF. The 'objective assessment of knowledge indicated a significant m improvement in' children's knowledge in the short-term. There were no statistically significant improvements in any of the other parameters assessed. The lack of significant improvements in self-management, behaviour, dietary intake and anthropometry may have been because the program had no effect, the parameters assessed or the instruments used (particularly the questionnaires) were not sufficiently sensitive, the sample size (which was determined by the CF population available) was too small or the duration of the intervention and follow-up was too short.Conclusion: Carers' unanimous recommendation of Go and Grow with CF, together with high levels of perceived learning, reported increase in confidence and improvement in children's knowledge in the short-term, indicate the benefits of the program.Although there was no statistically significant improvement in the anthropometric measurements after the intervention, 'the extensive data obtained during this study suggest that measurements of height and weight may underestimate the presence of poor nutritional status. It is likely that comprehensive assessments of body composition of children with CF would be useful in detecting mild degrees of malnutrition and in providing information about the effects of nutritional status on morbidity and mortality associated with the disease.Fat-based pancreatic enzyme replacement therapy dosing warrants further investigation given that parents had a strong preference for this method and that fat absorption remains abnormal in the majority of individuals who have pancreatic insufficiency. Evaluation of all pancreatic enzyme replacement therapy dosing methods are needed and this research suggests that dose should be assessed on a meal and snack basis, rather than just on daily intake, in order ++ / for levels of adherence to be examined.The apparent absence of a long-term effect of a single exposure to the program on knowledge suggests that regular, ongoing education and counselling is required by families to reinforce aspects related to the child's current stage of development and disease status.

Background: South Africa is experiencing a unique double burden of disease due to the nutrition transition, facing diseases related to both under and over nutrition. Childhood obesity is associated with a poor childhood diet, physical inactivity and sedentary lifestyle. Promoting healthy eating and physical activity is important. Promoting healthy eating patterns and regular activity are essential components of lifestyle modification of children. An obesity prevention programme with elements of music and dance for children aimed at improved nutritional knowledge to combat ignorance ofhealthy diets and highlight importance ofphysical activity seemed to be an ideal solution. Aim :The aim of this study was to investigate the effect of a novel nutrition intervention programme based on the South African food-based dietary guidelines (SAFBDG; musical play) on the transfer of nutritional knowledge towards a healthy lifestyle (healthy dietary behaviour and physical activity) in primary school children. Methods: Children (n=203; boys=93; girls=110), aged 6 to 12 years from different ethnic groups were recruited. Participation was voluntary. Only children whose parents/guardians gave written informed consent were included. Children were randomly assigned to a control group (n=99) exposed to the standard school nutrition curriculum and to an experimental group (n=104) who also participated in a musical play with short messages based on the SAFBDG for two sessions a week for five weeks. After each session pamphlets on the relevant SAFBDG message were given to the children to take home. At the end of the intervention the children performed the musical play for their parents/guardians. At baseline demographic information was obtained, anthropometrical measurements taken, a validated nutritional knowledge questionnaire administered and a 24-hour dietary recall completed. All measurements except the demographic questionnaire were repeated after the intervention. Results: Overall nutritional knowledge of the children exposed to the musical play increased with statistical and practical significance [11.9% (p < 0.05) versus. 11.1% (d> 0.05)]. Children 6 to 12 years consumed more grains and less dairy, vegetables, :fruit and meat than the recommended intakes. No measurable changes occurred in food group consumption after the intervention except for :fruit intake which increased in girls aged 8 -10 years in the experimental group (p < 0.05). Boys and girls aged 6 12 years have inadequate intakes « 67% of the Recommended Dietary Allowances (RDA)) of calcium, vitamins A, C, D, and B12, iron and folate. No statistically significant changes anthropometrical measurements were found after the intervention. Z-scores showed that children from the lower grades (grade 1 3) were more prone to stunting while children from the higher grades (grade 4 -6) were more prone to be obese. Furthermore, a high prevalence of overweight and obesity was found amongst white boys, whereas stunting was more prevalent amongst black boys and girls. Conclusion: The results of the study showed that the musical play based on the SAFBDG improved overall nutritional knowledge in a group of primary school children. Diet quality based on food group recommendations and nutrient intakes remained low which suggests that other factors apart from nutritional knowledge influenced food choices and, therefore, the diet quality in this group of children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2010.

Background: South Africa is experiencing a unique double burden of disease due to the nutrition transition, facing diseases related to both under and over nutrition. Childhood obesity is associated with a poor childhood diet, physical inactivity and sedentary lifestyle. Promoting healthy eating and physical activity is important. Promoting healthy eating patterns and regular activity are essential components of lifestyle modification of children. An obesity prevention programme with elements of music and dance for children aimed at improved nutritional knowledge to combat ignorance ofhealthy diets and highlight importance ofphysical activity seemed to be an ideal solution. Aim :The aim of this study was to investigate the effect of a novel nutrition intervention programme based on the South African food-based dietary guidelines (SAFBDG; musical play) on the transfer of nutritional knowledge towards a healthy lifestyle (healthy dietary behaviour and physical activity) in primary school children. Methods: Children (n=203; boys=93; girls=110), aged 6 to 12 years from different ethnic groups were recruited. Participation was voluntary. Only children whose parents/guardians gave written informed consent were included. Children were randomly assigned to a control group (n=99) exposed to the standard school nutrition curriculum and to an experimental group (n=104) who also participated in a musical play with short messages based on the SAFBDG for two sessions a week for five weeks. After each session pamphlets on the relevant SAFBDG message were given to the children to take home. At the end of the intervention the children performed the musical play for their parents/guardians. At baseline demographic information was obtained, anthropometrical measurements taken, a validated nutritional knowledge questionnaire administered and a 24-hour dietary recall completed. All measurements except the demographic questionnaire were repeated after the intervention. Results: Overall nutritional knowledge of the children exposed to the musical play increased with statistical and practical significance [11.9% (p < 0.05) versus. 11.1% (d> 0.05)]. Children 6 to 12 years consumed more grains and less dairy, vegetables, :fruit and meat than the recommended intakes. No measurable changes occurred in food group consumption after the intervention except for :fruit intake which increased in girls aged 8 -10 years in the experimental group (p < 0.05). Boys and girls aged 6 12 years have inadequate intakes « 67% of the Recommended Dietary Allowances (RDA)) of calcium, vitamins A, C, D, and B12, iron and folate. No statistically significant changes anthropometrical measurements were found after the intervention. Z-scores showed that children from the lower grades (grade 1 3) were more prone to stunting while children from the higher grades (grade 4 -6) were more prone to be obese. Furthermore, a high prevalence of overweight and obesity was found amongst white boys, whereas stunting was more prevalent amongst black boys and girls. Conclusion: The results of the study showed that the musical play based on the SAFBDG improved overall nutritional knowledge in a group of primary school children. Diet quality based on food group recommendations and nutrient intakes remained low which suggests that other factors apart from nutritional knowledge influenced food choices and, therefore, the diet quality in this group of children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2010.

Malnutrition is reported to be common in hospitals (10-60%), residential aged care facilities (up to 50% or more) and in free living individuals with severe or multiple disease (>10%) (Stratton et al., 2003). Published Australian studies indicate similar results (Beck et al., 2001, Ferguson et al., 1997, Lazarus and Hamlyn, 2005, Middleton et al., 2001, Visvanathan et al., 2003), but are generally limited in number, with none conducted across multiple centres or in residential aged care facilities. In Australia, there is a general lack of awareness and recognition of the problem of malnutrition, with currently no policy, standards or guidelines related to the identification, prevention and treatment of malnutrition. Malnutrition has been found to be associated with the development of pressure ulcers, but studies are limited. The consequences of the development of pressure ulcers include pain and discomfort for the patient, and considerable costs associated with treatment and increased length of stay. Pressure ulcers are considered largely preventable, and the demand for the establishment of appropriate policy, standards and guidelines regarding pressure ulcers has recently become important because the incidence and prevalence of pressure ulcers is increasingly being considered a parameter of quality of care. The aims of this study program were to firstly determine the prevalence of malnutrition and its association with pressure ulcers in Queensland Health hospitals and residential aged care facilities; and secondly to estimate the potential economic consequences of malnutrition by determining the costs arising from pressure ulcer attributable to malnutrition; and the economic outcomes of an intervention to address malnutrition in the prevention of pressure ulcers. The study program was conducted in two phases: an epidemiological study phase and an economic modelling study phase. In phase one, a multi centre, cross sectional audit of a convenience sample of subjects was carried out as part of a larger audit of pressure ulcers in Queensland public acute and residential aged care facilities in 2002 and again in 2003. Dietitians in 20 hospitals and six aged care facilities conducted single day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment, in either or both audits. Subjects excluded were obstetric, same day, paediatric and mental health patients. Weighted average proportions of nutritional status categories for acute and residential aged care facilities across the two audits were determined and compared. The effects of gender, age, facility location and medical specialty on malnutrition were determined via logistic regression. The effect of nutritional status on the presence of pressure ulcer was also determined via logistic regression. Logistic regression analyses were carried out using an analysis of correlated data approach with SUDAAN statistical package (Research Triangle Institute, USA) to account for the potential clustering effect of different facilities in the model. In phase two, an exploratory economic modelling framework was used to estimate the number of cases of pressure ulcer, total bed days lost to pressure ulcer and the economic cost of these lost bed days which could be attributed to malnutrition in Queensland public hospitals in 2002/2003. Data was obtained on the number of relevant separations, the incidence rate of pressure ulcer, the independent effect of pressure ulcers on length of stay, the cost of a bed day, and the attributable fraction of malnutrition in the development of pressure ulcers determined using the prevalence of malnutrition, the incidence rate of developing a pressure ulcer and the odds risk of developing a pressure ulcer when malnourished (as determined previously). A probabilistic sensitivity analysis approach was undertaken whereby probability distributions to the specified ranges for the key input parameters were assigned and 1000 Monte Carlo samples made from the input parameters. In an extension of the above model, an economic modelling framework was also used to predict the number of cases of pressure ulcer avoided, number of bed days not lost to pressure ulcer and economic costs if an intensive nutrition support intervention was provided to all nutritionally at risk patients in Queensland public hospitals in 2002/2003 compared to standard care. In addition to the above input parameters, data was obtained on the change in risk in developing a pressure ulcer associated with an intensive nutrition support intervention compared to standard care. The annual monetary cost of the provision of an intensive nutrition support intervention to at risk patients was modelled at a cost of AU$ 3.8-$5.4 million for additional food and nutritional supplements and staffing resources to assist patients with nutritional intake. A probabilistic sensitivity analysis approach was again taken. A mean of 34.7 + 4.0% and 31.4 + 9.5% of acute subjects and a median of 50.0% and 49.2% of residents of aged care facilities were found to be malnourished in Audits 1 and 2, respectively. Variables found to be significantly associated with an increased odds risk of malnutrition included: older age groups, metropolitan location of facility and medical specialty, in particular oncology and critical care. Malnutrition was found to be significantly associated with an increased odds risk of having a pressure ulcer, with the odds risk increasing with severity of malnutrition. In acute facilities moderate malnutrition had an odds risk of 2.2 (95% CI 1.6-3.0, p<0.001) and severe malnutrition had an odds risk of 4.8 (95% CI 3.2-7.2, p<0.001) of having a pressure ulcer. The overall adjusted odds risk of having a pressure ulcer when malnourished (total malnutrition) in an acute facility was 2.6 (95% CI 1.8-3.5, p<0.001). In residential facilities, where the audit results were presented separately, the same pattern applied with moderate malnutrition having an odds risk of 1.7 (95% CI 1.2-2.2, p<0.001) and 2.0 (95% CI 1.5-2.8, p<0.001); and severe malnutrition having an odds risk of 2.8 (95% CI1.2-6.6, p=0.02) and 2.2 (95% CI 1.5-3.1, p<0.001), for Audits 1 and 2 respectively. There was no statistical difference between these odds risk ratios between the audits. The overall adjusted odds risk of having a pressure ulcer when malnourished (total malnutrition) in a residential aged care facility was 1.9 (95% CI 1.3-2.7, p<0.001) and 2.0 (95% CI 1.5-2.7, p<0.001) for Audits 1 and 2 respectively. Being malnourished was also found to be significantly associated with an increased odds risk of having a higher stage and higher number of pressure ulcers, with the odds risk increasing with severity of malnutrition. The economic model predicted a mean of 3666 (Standard deviation 555) cases of pressure ulcer attributable to malnutrition out of a total mean of 11162 (Standard deviation 1210), or approximately 33%, in Queensland public acute hospitals in 2002/2003. The mean number of bed days lost to pressure ulcer that were attributable to malnutrition was predicted to be 16050, which represents approximately 0.67% of total patient bed days in Queensland public hospitals in 2002/2003. The corresponding mean economic costs of pressure ulcer attributable to malnutrition in Queensland public acute hospitals in 2002/2003 were estimated to be almost AU$13 million, out of a total mean estimated cost of pressure ulcer of AU$ 38 526 601. In the extension of the economic model, the mean economic cost of the implementation of an intensive nutrition support intervention was predicted to be a negative value ( -AU$ 5.4 million) with a standard deviation of $AU3.9 million, and interquartile range of –AU$ 7.7 million to –AU$ 2.5 million. Overall there were 951 of the 1000 re-samples where the economic cost is a negative value. This means there was a 95% chance that implementing an intensive nutrition support intervention was overall cost saving, due to reducing the cases of pressure ulcer and hospital bed days lost to pressure ulcer. This research program has demonstrated an independent association between malnutrition and pressure ulcers, on a background of a high prevalence of malnutrition, providing evidence to justify the elevation of malnutrition to a safety and quality issue for Australian healthcare organisations, similarly to pressure ulcers. In addition this research provides preliminary economic evidence to justify the requirement for consideration of healthcare policy, standards and guidelines regarding systems to identify, prevent and treat malnutrition, at least in the case of pressure ulcers in Australia.

Poor nutrition and impaired dietary intakes are associated with certain chronic disease states such as obesity, cardiovascular disease and diabetes. There have been a number of school-based, nutrition-focused interventions which have been used to measure and determine healthy eating behaviours in UK school children but with varying degrees of success. The main aim of this thesis was to develop, pilot and evaluate the Children’s Health, Activity and Nutrition: Get Educated! (CHANGE!), a healthy eating curriculum for year 6 children. A formative study, unique in this type of intervention study, was carried out to investigate the behaviours, habits and attitudes to food of the children and the data collected used to inform the design of the intervention teaching curriculum. It revealed the diversity of the food and eating environments to which the children were exposed. Some of their perceptions about health and food, food choices and eating behaviours were inter-related. The key health messages included in the teaching curriculum were developed from these findings. At baseline, the participants’ food intakes, knowledge about food and nutrition and their attitudes to eating were measured using questionnaires. Additionally anthropometric measurements were taken and the children’s postcodes used to assess the socio-economic status of the children. The results showed that the control and intervention groups were alike at baseline. At post-intervention, the results indicated that there were some positive changes to food intakes, with a slight decrease in the consumption of negative marker foods. There was an increase in the total mean food knowledge scores, with children from the areas of lower deprivation scoring highest. There was no significant difference between control and intervention groups. The children’s eating attitudes displayed some trends with cues to eating. There was a significant increase in height in all children but this did not alter the body mass index status of the overweight or obese children. The importance of the use of CHANGE! as an intervention at the school-level is demonstrated by some of the more important findings from the study, such as the increased self-assessed ability to make certain foods, and that there was an increase in total food knowledge scores from the children who lived in areas of lower deprivation. These results could potentially be the starting point for some children to start questioning the types of food they are habitually eating and maybe looking to make some adjustments to their behaviours, as even small changes can be nutritionally significant in the longer-term for the future health of the children. Furthermore, the sustainability and long-term effects of CHANGE! need additional assessment and evaluation.

With medical advancement and technology, generations are living longer. The process of aging is accompanied by development of chronic disease, reduced physical function, and increased risk of mortality. Older adults do not meet dietary requirements for fruits and vegetables due to lack of access, early satiety, socioeconomic factors, etc. Without proper attainment of fruit and vegetable recommendations, older adults are placed at risk of chronic disease. Interventions exist to help bridge the gap between older adult nutrition and currently established dietary guidelines. Built environments, such as community gardens, have received attentions in the public health arena as a successful way to engage the older adult population with benefits ranging from improved dietary behaviors to increased socializations and improved mental health. Many services for older adults are financially supported through the Older Americans Act. Interventions between community and academic entities require collaborative effort of the researchers at the university, the community members, as well as cooperative extension. Successful interventions engage all levels of the socioeconomic model. Engagement of all program stakeholders as well as clear communication and group collaboration serve as critical necessities in supporting a sustainable intervention of this kind.

The aim of the present study was to determine if a nutrition and yoga intervention will improve quality of life (QoL) in breast cancer survivors (BCS). Using the Transactional Model of Stress and Coping as a guide to lead the intervention, the intervention assessed potential barriers, self-efficacy, diet quality, and physical activity as it relates to quality of life. Twenty-seven women were enrolled in the study and randomly assigned to the control or intervention group. The intervention consisted of 6-weeks of yoga classes and 6-weeks of online nutrition education. The control group received a nutrition consultation and nutrition guidelines from the American Cancer Society. Measurement of variables was conducted at baseline, post-intervention (6 weeks), and follow-up (12 weeks). One-way repeated measures ANOVA, paired samples t-test, and post hoc analysis with Bonferroni adjustment was used to analyze the data. Mediation analysis with regression was performed to demonstrate the effect the intervention had on quality of life. The intervention elicited a statistically significant difference in the Total Outcome Index quality of life score from baseline to post-intervention (P < .005) and from baseline to follow-up (P < .005) in the intervention group. The frequency of how often fruits and vegetables were consumed was significant between time points, (P < .05), but not between the control and intervention group, P = .538. The amount of fruit and vegetables consumed each time was statistically significant for the intervention group from baseline to post-intervention (P < .05) however there was no significant difference from baseline to follow-up (P = .067). There was no difference between the control and intervention group, (P = .216). There was a statistically significant difference for physical activity for time (P P = .166) however the intervention group has a statistically significant difference between baseline and post-intervention (PP = .082). We cannot confidently predict that participant’s quality of life scores are determined by group with the help of mediators after conducting a mediation analysis with regression. A six-week nutrition and yoga intervention in BCS elicited significant changes in QoL in BCS. Even though the results did not show significant changes between the control and intervention group there were significant changes within the intervention group from baseline to post-intervention and baseline to follow-up which may indicate a 6-week online nutrition education program coupled with a 6-week yoga intervention an effective tool to improve QoL in BCS.