Objectives: The goal of this project was to determine the nutritional needs of preschool age children to help guide intervention development. The research aims were 1) to examine and describe young child (ages one to five) nutritional status as it relates to key nutrients associated with stunting and wasting; 2) to determine what key macro- and micro-nutrient deficiencies (primarily iron and zinc) are associated with wasting and stunting. Methodology: Study sample: Sixty-seven families with children ages one to five who participating in routine health care clinic visits during the UK Shoulder to Shoulder Global health brigade visits. Study design: A cross-sectional survey was conducted collecting demographic data, medical history, and dietary intake. Objective measures of height/length and weight were completed; and blood samples were drawn to measure serum micronutrient levels. Nutrition Data System for Research (NDSR) identified nutrient intakes for analytical comparison based on growth parameters. Nutritional and health status were compared to food security and World Health Organization growth reference points of standard deviations on Z-scores of height-for-age and weight-for-age. Analyses: Chi Square, ANOVA, and binary logistic regression tests were run using Statistical Analysis System (SAS) Results: Low serum levels of zinc and iron corresponded to low levels of dietary intake of zinc and iron, limited food security and moderate stunting z = -0 to 1.99 Standard Deviation. Conclusion: This study will inform a comprehensive nutritional intervention for this population. The evidence that specific nutrients are limiting will focus the health promotion objectives.

Title: Modification of body composition in spinal cord injury subjects undergoing six months intervention. Objectives: To determine the impact of six months intervention covering nutritional adjustments and excercise program on body composition in spinal cord injury subjects. Methods: Twenty-seven spinal cord injury subjects with the lesion level T4 - T12 (10 females, 17 males) mean age 41.9 ± 10.3 years and initial BMI 27.02 ± 5.0 kg/m participated in the present study. Body composition was measured using the multi-frequency bioelectrical impedance analysis device Bodystat QuadScan 4000. Statistical analysis was carried out in the statistical program IBM SPSS statistics 22. Intervention lasting six moths constisted of 2 weeks intensive program, followed by 5 months home based program and 2 weeks of intensive program. The inicial assessment was made before the intervention and follow-up right after. Results: Although a body mass decreased (p ˂0,001), body fat percentage and FM increased (p = 0.193). Furthermore, muscle mass (MM) (p = 0.002), total body water (TBW) (p = 0.002), intracellular fluid (ICW) (p = 0.016), and extracellular fluid (ECW) (p = 0.001) decreased. Decreasof ECW / TBW (p ˂0,001) suggests reduction of edema. Conclusion: Even though generally a change of eating habits and exercise...

Enrollment of preschool aged children in childcare centers has risen drastically in the last few decades, and continues to rise. This presents a great opportunity for childcare providers to administer nutrition information to children during this optimal learning phase of their life, because information learned during this phase will influence a child’s behaviors and beliefs towards food for the rest of their life. Even with this opportunity, research has shown that many facilities are not including nutrition information in their curriculum. Barriers are often cost, training, and staffing. This understanding led to piloting this nutrition intervention using the age-appropriate USDA MyPlate eBooks. The aim of this research was to improve nutrition knowledge, beliefs, and behaviors in preschool-aged children, while further evaluating the validity and reliability of a scale designed by Johnson and Malkus to measure these constructs. Twenty-five preschool-aged children from two community childcare facilities were enrolled in the study. A pretest assessing performance on nutrition-related tasks was administered using the scale via iPad technology. During the intervention, this researcher read one new story each week for 6-weeks from the USDA’s Team Nutrition MyPlate eBook series. Topics included Fruits, Vegetables, Grains, Dairy, Protein, and A MyPlate meal. The same assessment was administered post-intervention. Scores for individual subscales and a total score were tallied for each child. Data was analyzed using IBM SPSS Statistics 25. Paired-samples t tests were conducted to determine if the intervention in this sample of preschoolers improved their performance on measures of nutrition knowledge, beliefs, and behaviors. The results indicated that mean scores on the food identification subscale (M= 6.12, SD = .83) were significantly greater post-intervention than pre-intervention (M = 5.12, SD = 1.3), t(24) = 5.22, p < .001. Mean scores on the food group categorization subscale (M= 10.96, SD = 2.5) were significantly greater post-intervention than pre-intervention (M = 8.88, SD = 2.4), t(24) = 4.278, p < .01. Mean scores on the total scale (M = 59.84, SD = 7.15) were significantly greater post-intervention than pre-intervention (M = 55.4, SD = 7.06), t(24) = 3.145, p < .01. Knowledge about the health of foods does not always predict behavior. It was not surprising that in this age group, mean scores on the behavior subscale were not significantly improved by the intervention; pre (M= 11.44, SD 2.70), post (M= 11.32, SD 3.10), t(24) = -0.166, p = 2.58. These results foster the theory that nutrition knowledge in preschool-aged children can be positively influenced with clear and age-appropriate education. It was also clear that affecting behavior is more difficult. When offered less healthy, but tasty, preferred foods, young children are less likely to choose healthy options. This further supports the understanding that the responsibility of adults is to provide healthy foods to children. Future research will include pre-post testing without intervention and comparison of results.

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.

Les populations défavorisées sont souvent peu réceptives aux messages de santé publiques, perçus comme trop complexes et peu adaptés. De nombreuses interventions nutritionnelles ont été menées, y compris en magasin, mais l’impact de ces interventions sur les comportements d’achats reste peu convaincant. L’utilisation des principes et des techniques issus du marketing pourrait constituer une stratégie efficace pour développer des interventions adaptées à ces populations.L’objectif de cette thèse était de développer, mettre en oeuvre et évaluer une intervention nutritionnelle dans deux magasins dans les quartiers Nord de Marseille, selon la méthode du marketing social. Pendant 6 mois, une sélection d’aliments peu coûteux et de bonne qualité nutritionnelle ont été mis en avant via un étiquetage en rayon, soutenu par une campagne de communication et des actions promotionnelles en magasin : dépliants, affiches, tête de gondole, stand de dégustation. L’analyse des achats des clients a montré un effet positif de l’intervention sur l’achat de féculents et de fruits et légumes. Un questionnaire rapide à la sortie des magasins a montré que 31 % des clients ont remarqué l’opération, et que ce pourcentage était plus élevé à la fin de l’intervention. Un questionnaire plus approfondi a montré que les clients ayant remarqué l’intervention obtenaient des scores plus élevés à un quiz sur la nutrition et comprenaient mieux le système d’étiquetage que les clients ne l’ayant pas vue.Bien que ces résultats soient plutôt encourageants, un certain nombre de questions demeurent, en particulier sur la temporalité du changement de comportement, l’importance de la segmentation de la cible et la prise en compte des comportements irrationnels et inconscients dans le marketing social. / Low-income populations are often unreceptive to public health messages that may be perceived as too complex and poorly adapted. Many nutrition interventions have been conducted, including store-based interventions, but their impact on purchase behaviors is not convincing. The use of marketing principles and techniques could be an effective strategy for developing interventions adapted to these populations.The objective of this PhD was to develop, implement and evaluate a nutrition intervention in two stores in the northern districts of Marseille (France), using a social marketing approach. For six months, a selection of inexpensive foods of good nutritional quality was promoted through shelf labeling, supported by a communication campaign and in-store promotional actions: leaflets, posters, endcap placement, tasting booth. Analysis of customer purchases showed a positive effect of the intervention on the purchases of starchy foods and fruits and vegetables. An exit survey revealed that 31% of customers had seen the intervention, and that this rate was higher at the end of the intervention. A more in-depth survey showed that customers who saw the intervention scored higher on a quiz about nutrition and had better understanding of the labeling system than did customers who had not seen the intervention.Although these results are rather encouraging, questions remain, in particular about the temporality of behavioral change, the importance of target segmentation and the consideration of irrational and unconscious behavior in social marketing.

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.

The obesity epidemic is a global health concern. In the United States alone, 68.5% of adults are categorized as overweight or obese; of these, 35.1% are considered obese. Obesity is a leading cause of morbidity and mortality from diabetes and cardiovascular disease, two diseases adversely affecting minority groups such as Mexican Americans. Yet, a modest 5% decrease in weight, through changes in diet and physical activity, can help control type 2 diabetes. The current study extracted the dietary data and selected outcome variables from Beyond Sabor, a 12 week intervention conducted in the Lower Rio Grande Valley, Texas, a predominantly Mexican American disadvantaged community. Social Cognitive Theory, guided the design of this culturally tailored intervention. Community resources and natural helpers emerged through the utilization of community based participatory research methods. Study participants (n= 1,273) were recruited from local food bank sites and randomized into treatment and control groups. The treatment group received 12 weekly sessions focusing on healthier eating habits, cooking methods, and physical activity. The control group received 6 nutrition education sessions on similar topics. The study measured changes in several food groups including consumption of soda, fruit juice, and fruit and vegetables. A repeated measures Analysis of Variance was employed to determine changes in treatment and control groups from baseline, post intervention and 40 week follow up. The results showed a significant decrease in soda (F= 8.48, p< .001) and fruit juice (F= 3.12, p= .045) consumption for both groups, with a particular decrease in soda for the treatment group. In addition, there was a significant increase in fruit (F=15.32, p< .001) and vegetable (F=3.16, p= .04) consumption in both groups. The outcome variables selected were weight, body mass index (BMI), and fasting plasma glucose (FPG). There were significant changes for all three variables over time. The intervention resulted in changes in dietary behaviors that ultimately led to changes in weight, BMI, and FPG. It is evident from the current study, that the use of community based helpers facilitated changes in food habits. This study serves as a prognosticator for future interventions.

p. 1-173 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-09T18:22:51Z No. of bitstreams: 1 Dissertacao Priscila Ribas SEG.pdf: 674273 bytes, checksum: 7e4b5ec69af904995d5de81f930499ff (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-18T19:28:46Z (GMT) No. of bitstreams: 1 Dissertacao Priscila Ribas SEG.pdf: 674273 bytes, checksum: 7e4b5ec69af904995d5de81f930499ff (MD5) / Made available in DSpace on 2013-04-18T19:28:46Z (GMT). No. of bitstreams: 1 Dissertacao Priscila Ribas SEG.pdf: 674273 bytes, checksum: 7e4b5ec69af904995d5de81f930499ff (MD5) Previous issue date: 2009 / Introdução: A dislipidemia tem sido indicada como um dos mais importantes fatores de risco para a doença cardiovascular (DCV), uma das DCNT de maior prevalência em todo o mundo. A alimentação inadequada associada ao sedentarismo tem sido responsabilizada pela alta ocorrência das dislipidemia. Objetivo: avaliar a influência de um programa de intervenção baseado na Estratégia Global da OMS sobre a mudança no perfil lipídico das participantes. Metodologia: trata-se de um estudo de intervenção quasi-experimental do tipo antes e depois, baseada na intervenção nutricional e atividade física, com duração de 12 meses, envolvendo 69 mulheres de 20 a 59 anos, submetidas a exames bioquímicos e avaliação nutricional no início, aos 6 e aos 12 meses do seguimento. A Equação de Estimação Generalizada foi a técnica estatística usada para avaliar as associações planejadas. Resultados: A prevalência da hipercolesterolemia foi de 71% entre as participantes; níveis séricos indesejáveis de LDL-colesterol, HDL-colesterol e triglicérides foram observados, respectivamente em 31,9%, 36,2% e 31,9%, delas. Pela análise de GEE, a cada unidade de aumento no escore médio de consumo diário dos alimentos do grupo das gorduras e frituras, houve um aumento de 56,33mg/dl (p<0,01) e de 24,70 mg/dl (p<0,01) nos níveis séricos de colesterol total e LDL-Colesterol, respectivamente. Observou-se ainda que o menor nível de atividade física elevou em 15,68mg/dla (p=0,0145) a média de triglicérides séricos, quando comparado com os níveis mais. O HDL-Colesterol não se associou à intervenção. Conclusão: a intervenção mostrou-se associada à redução da gravidade da dislipidemia nas participantes. / Salvador

<div>The first 1000 days of life, from conception until the child’s second birthday, constitute a critical window for child growth and development. During infancy and early childhood, significant and rapid physical changes occur, including increases in weight, height, and brain size and organ development accompanied by cognitive and psychomotor development. Adequate infant feeding, including breastfeeding and complementary feeding, that meets the infants’ energy and nutrient requirements can help protect against growth faltering, infant and child morbidity and mortality, and delayed mental and motor development. Adequate nutrition during this critical period can also protect against adverse health outcomes and chronic diseases later in life according to the hypothesis of developmental origins of health and disease.</div><div><br></div><div>A web of factors that are country- and culture- specific influence infant feeding practices and child growth. Further, the microbiome has been suggested as a strong potential player in the association between infant nutrition and child growth. Therefore, the overarching theme of the current dissertation is to investigate hypotheses that can provide evidence to inform the paradigm linking socio-demographic, maternal, and child determinants including prenatal intake to infant feeding, the breast milk and infant gut microbiome, and child growth within the first 1000 days of life. Specifically, aims one and two examine the socio-demographic, maternal, and child determinants of child growth and breastfeeding in a cross-sectional survey of mother-child dyads in Lebanon, a middle-income country undergoing nutrition transition in the Middle East. The third aim focuses on the CHILD cohort study, a multi-center longitudinal prospective birth cohort study, to examine the associations between prenatal diet and supplement intake and the breast milk microbiome. Finally, the fourth aim is to review the evidence for the potential of the infant gut microbiome as a promising target linking complementary feeding to child undernutrition in low- and middle- income countries (LMIC) with the highest burden of undernutrition.</div><div><br></div><div>The results for aim one revealed sex-specific determinants of child growth in Lebanon. The determinants examined through a hierarchical conceptual framework included: maternal and paternal education among boys and crowding index among girls at the distal sociodemographic level, and maternal obesity among girls at the intermediate maternal level. The proximal child determinants included birth length, number of children in the household and breastfeeding duration among girls, birthweight among boys and child’s age among boys and girls.</div><div><br></div><div>In the analysis for aim two, breastfeeding practices were suboptimal in Lebanon as less than half (41.5%) of the infants were exclusively breastfed during the 40-day rest period and 12.3% were exclusively breastfed during the 6-month duration recommended by the World Health Organization. Higher socioeconomic status, as reflected by a larger number of cars owned, and C-section delivery were consistently inversely associated with lower odds of exclusive breastfeeding for 40 days and 6 months. Belonging to a family with more children was associated with higher odds of exclusive breastfeeding for 40 days; while maternal overweight and obesity were associated with lower odds of exclusive breastfeeding for 6 months.</div><div><br></div><div>Findings from aim three suggested that prenatal supplement use, but not prenatal dietary quality and patterns, modulate the breast milk microbiota composition in the CHILD cohort in Canada. This project was exploratory and utilized one of the largest birth cohort studies with available breast milk microbiome data. Specifically, use of vitamin C and D supplements plus multivitamins during any trimester in pregnancy was consistently associated with milk microbial diversity and genus composition before and after adjustment for socio-demographic, maternal, and child covariates. Use of other supplements such as fish oil, folate, and calcium was less consistently associated with the breast milk microbiome.</div><div>The fourth aim of the review chapter focused on the infant gut microbiome. The effects of complementary feeding on the infant gut microbiome are less commonly studied than those of breastfeeding, with most research conducted in high-income countries but not LMIC. In contrast, associations between inadequate complementary feeding and undernutrition have been examined in LMIC where undernutrition is most prevalent. Further, a disrupted gut microbiota has been associated with child undernutrition. Indeed, animal studies have suggested a causal association although the direction of the causality is not clear and is potentially bi-directional depending on genetic and environmental conditions. In light of the current state of knowledge described in our review supporting the potential of the gut microbiota as a key player in the relation between complementary feeding and undernutrition, the development of microbiota-directed interventions during the complementary period offers a promising route for undernutrition management.</div><div><br></div><div>Findings from the studies presented in this dissertation highlight several culture-specific determinants of child growth and breastfeeding in Lebanon. The findings also highlight the need for future research using longitudinal prospective cohorts, intervention trails and animal models to provide evidence for the proposed links to enhance the understanding of the paradigm. Such a holistic view of the determinants of and pathways between infant feeding and child growth are of great public health significance to improve the health of children throughout their lives.</div>

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