A Research Project Submitted in partial fulfilment of the requirements for the Master of Science Degree in Epidemiology and Biostatistics / Background: There is evidence suggesting a considerably high prevalence of malnutrition in Zimbabwe. However, there is little evidence available to suggest the factors that may be associated with malnutrition in the local context. Objectives: This study investigates the distribution of malnutrition and the factors associated with each of three types of malnutrition (stunting, wasting and underweight) among Zimbabwean children aged 0-59 months for the period 2010/2011 Methods: The study makes use of the Zimbabwean Demographic and Health Survey (ZDHS) data from the 2010/11 survey. SaTScan software was used to identify clustering of malnutrition outcomes at the time of data collection. Binary Logistic regression for survey data was used to determine factors associated with each type of malnutrition, while unconstrained Generalised Ordered Logistic (GOLOGIT) regression for survey data was used to determine the factors associated with a four-level ordinal malnutrition variable, generated by summing up all the types of malnutrition a child had at the time of data collection. Bayesian hierarchical spatial models were built in INLA to incorporate spatial autocorrelation in the modelling of malnutrition. Results: Factors associated with at least two types of malnutrition in this study were mother’s body mass index (BMI), mother’s breastfeeding status, child’s sex, age group, birth weight category and twin status as well as household’s wealth index. There was a consistent observation that female children were at a less risk for malnutrition than males and also that higher birth weight was protective of malnutrition. There was no clustering of malnutrition outcomes. The spatial random components that were added to the Bayesian hierarchical models did not improve any of the models. Conclusion: The findings from this study are consistent with findings from other researches and identify the factors associated with each of the common types of malnutrition. In addition the study reveals that there was no particular spatial distribution of malnutrition outcomes at the time of data collection. The study suggests further investigation of the effects of dietary diversity and mothers’ decision making power on malnutrition. Zimbabwean policy makers can make use of the findings from this study to provide evidence on which to base nutritional programmes in the country.

Diss. (sammanfattning)--Umeå : University, 2004. / Härtill 5 uppsatser.

Thesis (M.Sc. in Nutrition) -- Faculty of Graduate Studies, Mahidol University, 1979. / Financial support by National Research Council.

Introduction: Non-milk extrinsic sugar {NMES} intake among children in Scotland fails to meet dietary recommendations, which is likely to contribute to dental decay and weight gain. Children's physical activity, which contributes to energy balance, also fails to meet recommended targets. Aim: To develop and evaluate a classroom based educational intervention to improve knowledge of NMES and energy balance in children aged 10-12 years. Methods: Following development of an intervention, consisting of two educational sessions, one on NMES and one on physical activity and energy balance, a cluster-randomised trial was conducted with 268 children in 15 primary schools {8 controls}. Children completed questionnaires to assess their knowledge of NMES and energy balance and levels of physical activity at baseline and 4, 10 and 34 weeks post intervention. Intake of NMES was assessed at baseline, and at weeks 10 and 34 using a food frequency questionnaire. After the intervention, focus groups were conducted to explore children's views and opinions of NMES and the educational sessions. Results: At baseline children had limited knowledge of NMES. Post intervention, the intervention group had a significantly higher knowledge than the control group, but this declined by 34 weeks. Knowledge of energy balance between the groups was not significantly different post intervention. No changes in NMES intake or physical activity were observed post intervention. Focus groups highlighted that children did not consider health to be a priority for dietary choice. They thought it was important to learn about NMES, but were disinclined to reduce their intakes. Conclusions: Despite improved knowledge of N MES and the health consequences of excess consumption, children are unlikely to change dietary behaviour when it requires over-riding their taste preferences. Education helps children to understand healthy lifestyle behaviours, but following this, environmental changes may be necessary to facilitate behaviour change.

MSc (Med), Child Health, Faculty of Health Sciences, University of the Witwatersrand, 2011 / Background: The long term effect of infant nutrition on later body composition has gained global attention since the developmental origins of health and disease because of the association between early life outcomes and later adult health (1). Under-nutrition and growth faltering during prenatal and infant periods have been reported to be related to subsequent growth faltering, high fat mass, and low lean and bone mass. Early life nutritional environmental cues may cause permanent effects on the physiology, metabolic and endocrine system of the body. Objective: We investigated the association of infant nutrition and anthropometry with subsequent child anthropometry and body composition at age 9/10 years. Design: This study comprised of 140 children who had infant growth measures and dual-energy X-ray absorptiometry (DXA) conducted at age 9/10 years. They were selected from the Bone health sub-study of 408 black children of the Birth-Twenty longitudinal study cohort comprising of children born in Soweto, Johannesburg in 1990. Data collection and analysis: Data was collected on following variables; infant feeding, socio-economic status at delivery, anthropometry (birth weight, height and weight at ages 1, 2, 9/10 years). Body composition data was obtained from DXA scans. Food frequencies questionnaires were used for dietary patterns data collection. Data cleaning and analysis of data which encompassed descriptive, bivariate and multivariate analyses were done in STATA 10 and the 5% level of significance was used for statistical significance. Results: Children were breast-fed on average for 13 months in boys and 16 months in girls (p=0.009) while those bottle fed had a duration of 10 months for both sexes. Introduction of solid foods was around 3 months while the approximate mean dietary diversity score (the number of food groups consumed by an infant in a 24-hour recall period) was 1 and the food iv variety score (the number of food items consumed by an infant in a 24-hour recall period) was 2 for both girls and boys. Prevalence of stunting, wasting and underweight at 1 year was 8.6%, 3.6% and 8.6% respectively. At age 2 years, the prevalence was 15.7%, 8.6% and 16.4% for stunting, wasting and underweight, respectively. All the associations between infant nutrition variables and subsequent growth and body composition at age 9/10 years were statistically non-significant. In the multivariate model, increase in birth weight predicted an increase in weight and height at ages 1, 2 and 9/10 years, lean mass (β=0.20, CI=0.01-0.03, p=0.007), radius (β=0.02, CI=0.00-0.04, p=0.039) and lumbar spine (β=0.03, CI=0.01-0.05, p=0.018). Infant weight and height at 1 year were significantly positively associated with subsequent growth at 2 and 9/10 years and with body composition variables. Stunting at age 1 year was significantly associated with lower fat mass (β= -0.18, CI= -0.03 to -0.06, p=0.003) while stunting at age 2 years predicted lower fat only (β= -0.12, CI= -0.22 to -0.03, p=0.011) after adjusting for confounders. Being underweight at age 2 years predicted lower fat mass in the multivariate model. Conclusion: Infant nutrition had no significant influence on subsequent growth and body composition. Birth weight and infant anthropometry; particularly height, weight, stunting and underweight are the main predictors of body composition at age 9/10 years. There is need for promotion of optimal prenatal and infant growth in children to reduce risk of chronic diseases like Type 2 diabetes, hypertension and osteoporosis in later life.

Childhood overweight and obesity is a significant public health concern, especially among children of different racial and socioeconomic backgrounds. This dissertation provides insight into one such population: Asian youth in the U.S. Three studies - two literature reviews and one quantitative study - compose this dissertation, which aims to understand dietary behaviors of Asian-American youths using a theoretical framework. The first study is a systematic literature review of existing health education/promotion theories and models used to study eating/feeding practices for preschool-aged children. The main purpose of this study was to review and critique theories and constructs utilized in nutrition research on preschool-aged children, while also providing recommendations for strengthening theory utilization and diversifying nutrition research in the future. Forty articles were included, of which 43% had clear identification of theory/constructs and a strong theoretical framework. The most common finding was modeling's effect on children's dietary behaviors, followed by the relationship between parental restriction/control and children's dietary behaviors. The second study was a systematic literature review of dietary behaviors of children of Asian background in the U.S. The aims of this review were three-fold: (a) to review literature regarding Asian-American youths' dietary behaviors, (b) to critically evaluate the methodological quality of such research, and (c) provide recommendations for future nutrition-related research on Asian-American youths. Fifteen articles were included. Major findings included: (a) frequent consumption of milk, fruit, meat, unenriched white rice, vegetables, and high-fat and high-sugar items among Asian-American children and (b) acculturation's effect on Asian-American youths' dietary behaviors. The third study was an investigation of cognitive, behavioral, and environmental influences on dietary behaviors of Asian-American preschool-aged children on WIC using Social Cognitive Theory. Analyses included descriptive statistics and multiple linear regression on a sample of 68 Asian caregiver-child pairs in Texas. Results revealed consumption of 100% juices, fruits, vegetables, and white rice. In addition, adult fruit consumption frequency, adult potato consumption frequency, adult other vegetable consumption frequency, and outcome expectancies were statistically significant predictors of child's fruit and vegetable consumption. The findings from this dissertation will help nutrition education and health professionals culturally tailor obesity prevention programs for Asian Americans.

Thesis (M.Sc. (Biostatistics))--Mahidol University, 1982.

Purpose: To evaluate implementation and impact of school nutrition policy (SNP) using a qualitative case study approach. Sample/Setting: participants (n=79) from two elementary schools and one secondary school within one school division in Winnipeg, Manitoba consented to participate. Methods: Perceptions of teachers, parents, administrators, students, custodians, education assistants, and food service operators were explored using observations, interviews and focus groups. Results: Implementation and impact varied between schools. Common barriers include: negative attitudes, inadequate school and community resources and ineffective communication. Major impacts include changes to; food sales and nutrition awareness. Conclusions: Impacts of the SNP have been noted however, barriers need to be addressed to provide schools the best opportunity for success. Each key informants group provided useful insights into implementation and impact of SNP. Implications: This study demonstrates the importance of considering multiple perspectives when evaluating SNP. Results will be useful to policy makers to inform future SNP efforts.

Purpose: To evaluate implementation and impact of school nutrition policy (SNP) using a qualitative case study approach. Sample/Setting: participants (n=79) from two elementary schools and one secondary school within one school division in Winnipeg, Manitoba consented to participate. Methods: Perceptions of teachers, parents, administrators, students, custodians, education assistants, and food service operators were explored using observations, interviews and focus groups. Results: Implementation and impact varied between schools. Common barriers include: negative attitudes, inadequate school and community resources and ineffective communication. Major impacts include changes to; food sales and nutrition awareness. Conclusions: Impacts of the SNP have been noted however, barriers need to be addressed to provide schools the best opportunity for success. Each key informants group provided useful insights into implementation and impact of SNP. Implications: This study demonstrates the importance of considering multiple perspectives when evaluating SNP. Results will be useful to policy makers to inform future SNP efforts.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2004.