Nutritional support for bone marrow transplant recipients is recognized as vital, yet little research has occured to determine the best method. This study was designed to survey existing food and nutrition services in bone marrow transplant centers in the U.S. in order to determine similarities in the services provided among centers from which a model protocol could be established for such centers. A survey instrument was developed and sent to all chief dietitians associated with BMT centers in the U.S, listed the International Bone Marrow registry, 1982. Items on the questionnaire included: background information on size and organization, nature of foodservice, and nutrition support services. The research suggested that there was a trend away from sterile food service. Problems encountered in establishing the food and nutrition services included: availability of single-serve sterile foods, standardization of recipes, and palatability of autoclaved foods. Four centers switched from sterile diets to either low bacteria diets or modified house diets at some point in their operation. Patient related services of the registered dietitian were most concentrated on admission and during critical care monitoring. Near all respondents indicated a desire to form a network for developing standards for services provided. Many differences between centers still remain which prevent the development of a model center.

Studies have estimated total daily salt consumption in the U.S. at 10 - 14.5 grams, despite increasing public awareness and decreased usage by the food industry. To avoid excess governmental regulation to modify current salt intake, determination of the amount of salt currently being used in a discretionary manner is needed. This study investigated the feasibility/limitations of a data collection technique to assess discretionary salt intake in in-flight meal service, Discretionary salt use by airline passengers was determined by weighing salt packets remaining on used meal trays. Results showed an average discretionary salt consumption of 167 milligrams/meal among passengers able to add up to one gram of salt to their meal. At least 63% of the passengers used no discretionary salt, Intake was not influenced by sodium content of the menu, different flight days, or inclusion of a salad with the meal. Salt usage appeared to be an "indescriminate" function of habit. The data collection tool proved a feasible method for estimating discretionary salt intake and could be useful in future consumer education studies.

A healthy diet has been established as a key component contributing to an individual’s quality of life. Statistics show that the diet of Americans needs improvement (Guenther et al., 2007) indicating possible lack knowledge of what healthy eating behaviors are. There is an abundance of nutrition misinformation available to the consumer (American Dietetic Association, 2002a). Dietary interventions that provide credible education based on readiness to change behaviors and goal setting have been successful in increasing awareness of what healthy eating behaviors are and changing existing behaviors over time (Ammerman et al., 2002; Evans & Sawyer-Morse, 2002; Gambera et al., 1995; Hebert et al., 1999; Oenema & Brug, 2003; Proper, et al., 2003). In an effort to provide a college community with credible nutrition education based on dietary analysis and stage of change, a nutrition assessment and consultation program was developed and implemented at a college campus during the fall 2003 quarter. It was integrated into the existing fitness testing and prescription program, polyFIT. Seven students, referred to as fitness consultants, majoring in Nutrition or Kinesiology were recruited and trained to distribute appropriate education based on individual clients’ dietary analysis, a stage of change assessment and personal goals. Intervention materials were constructed using a variety of resources focusing on areas of nutrition. Thirty clients participated during the fall 2003 quarter; all were freshman and sophomores enrolled in a Healthy Living course. Separate survey questionnaires were designed for the consultants and the clients to gather their perceptions of the program components. PolyFIT continued to offer the program, modifying it over time, for at least 4 years after the initial implementation.

The gut microbiota and its metabolites – namely short chain fatty acids (SCFAs) – interact with the digestive, immune, and nervous systems. Microbiota with disrupted composition are highly associated with obesity, gastrointestinal symptoms, and chronic inflammation. Levels of SCFAs in the feces can represent dynamics of the microbiota, and they represent one mechanism by which the microbiota interacts with its host. This study aimed to further our understanding of associations between microbiota bacterial diversity and SCFAs, immune markers, BMI, and GI symptoms and to identify bacteria that are differentially abundant in different BMI groups and with synbiotic supplementation. Data (SCFAs, immunoglobulins, body mass index, fecal fiber, fecal protein, measures of GI symptoms, and 16s RNA sequences, n=11) was extracted from a randomized control trial investigating the effects of synbiotic supplementation in non-celiac gluten-sensitive participants. QIIME2 was used to process 16s RNA data, analyze quantitative, qualitative, phylogenetic quantitative, and phylogenetic qualitative measures of alpha and beta diversity and to perform an analysis of composition of microbiomes (ANCOM) for identification of differential abundances. Multiple metrics of alpha diversity were found to significantly correlate with IgG4, IgM, IL-2, acetate, propionate, isobutyrate, valerate, isovalerate, caproate, heartburn, urgent need to defecate, and feelings of incomplete evacuation. Multiple metrics of beta diversity were significantly different between normal and overweight, normal and obese, and overweight and obese BMI classification groups. Beta diversity was also found to significantly correlate with IgG1, IgG3, IgG4, IgA, IL-6, IL-8, fecal fiber, propionate, butyrate, heartburn, acid regurgitation, nausea and vomiting, bloating, abdominal distension, increased gas, and eructation. The synbiotic intervention did not significantly alter alpha or beta diversity. An ANCOM identified bacterial taxa differentially abundant with BMI shifts and synbiotic supplementation, though these taxa were not those included in the synbiotic. Findings demonstrate alpha and beta diversity associations with various SCFAs, GI symptoms, immune markers, and BMI, and the results of the placebo-controlled intervention suggest careful consideration of placebo contents moving forward. This research supports plans to apply analysis to larger sample sizes to elucidate changes microbial profiles that are associated with clinically relevant biomarkers and symptoms.

The importance of proper nutrition education among older adults is crucial in promoting overall physical health and management of chronic health conditions. However, access to such education has been limited, especially during the COVID-19 pandemic. With the current boom in social media popularity, as well as virtual communication portals such as Zoom, the question must be asked if nutrition education could be effectively implemented for the use of older adults through these electronic channels. The study design for this particular research was a cross sectional survey to inform development of an online nutrition education program for older adults in Northeast Tennessee. (Appendix B). The survey was distributed as a paper-based survey in seven senior centers and as an online Qualtrics survey distributed by all senior center directors in Northeast Tennessee. A total of 160 surveys were collected (61 paper-based, 99 online), with 150 surveys being complete. Frequencies showed that the majority of participants have internet access and use social media platforms, such as Facebook and YouTube, which was not affected by home location, such as rural versus urban. Most participants were interested in participating in a nutrition education program. The survey also revealed more information about seniors in Northeast Tennessee that will be helpful when developing this program.

Introduction: The gut microbiome is believed to have a significant impact on health throughout the lifespan, and the influence of infant nutrition and other environmental factors are of particular interest in its development. The aim of this research project was to learn more about the microbiome and short chain fatty acid (SCFA) composition of toddlers of differing weights, considering birth history, environment, and diet. In East Tennessee, opioid misuse is a growing issue, and a number of participants in this study were exposed in utero. We also hoped to identify related effects on infant’s SCFA composition. Finally, it is known that twins share a variety of traits, but much about their microbiome is unknown. With several pairs of twins in the sample, we aimed to identify any associations with SCFAs in this group. Methods: With informed consent, the child’s history was obtained, including age, birth length and weight, delivery type (C-section or vaginal), and feeding method (breast, bottle fed, or both). The child’s current weight, height, and BMI percentile were determined. Caregivers completed a 90-question Block Questionnaire for Ages 2-7 Kids food frequency questionnaire, and results were analyzed by Berkeley Analytics Inc (dba NutritionQuest). Participant-provided stool samples were freeze-dried and ground, and SCFAs were extracted and analyzed by content area % and concentration ppm. Data analysis was generated using SAS software, Version 9.4 of the SAS System, Copyright © 2013 SAS Institute Inc. Results: Nine SCFAs were measured in duplicate, and the concentrations averaged. Statistical analysis included comparisons of SCFAs related to factors including weight status, infant feeding modality, twin status, and intrauterine drug exposure, and significance determined with a p value < 0.05. Results did not identify significant differences in individual SCFA concentrations between obese and non-obese toddlers, however concentrations of isobutyrate, isovaleric acid, and octanoic acid were greater in toddlers who were formula fed as infants versus toddlers who were breastfed, and those fed a combination of breastmilk, and formula. Analysis further revealed a higher mean concentration of caproic and propionic acid in twin subjects. Of particular interest, toddlers with a history of opioid exposure had higher mean concentrations of isovaleric and octanoic acids, but less isocaproic acid when compared to those who were not drug exposed. Further analysis will help determine if these findings may be related to nutrient intake, in particular dietary fiber intake.

In westernized culture, there is a deficit of healthy fats in the average person’s diet. Decreased intake of omega-3 fatty acids has been correlated to many different conditions such as cardiovascular disease, cancer, and chronic inflammatory issues. The “Mediterranean Diet” has been proposed as an ideal way to combat these issues. This diet promotes fish as a protein source and as a way to increase intake of essential polyunsaturated fatty acids. Due to location and dietary trends, fish is less often the main component of Northeast Tennessee's diet. This study investigated ways to fortify a more commonly consumed food in western culture, marinara sauce, with flaxseed oil, walnut oil, or anchovies. These fortified marinara sauces were compared to a commercial sauce, Paul Newman’s Marinara. We hypothesized that adding omega-3 rich ingredients to a base marinara sauce recipe will significantly vary the fatty acid profile and increase the amount of omega-3 fatty acids and decrease the omega-6 to omega-3 fatty acid ratio. Marinara sauces were prepared and analyzed using proximate analysis methods to evaluate each variant sauce for macronutrient distribution. Preparation included cooking, freeze-drying, and grinding the variants into a fine powder. The tests that we performed included: bomb calorimetry, Kjeldahl protein analysis, Soxhlet fat analysis, ash/mineral analysis, FRAP Assay of antioxidant content, and gas chromatography to characterize fatty acid profiles. The focus of our proximate analysis was investigating the fatty acid composition to answer our main research question. Other tests conducted allowed us to understand better the nutrient composition of the 3 variants for possible future studies. The three variants showed a better omega-6 to omega-3 fatty acid ratio than the Paul Newman’s sauce. Samples with the highest to lowest omega-6 to omega-3 ratio were Paul Newman's Marinara, Anchovies, Walnut Oil, Flaxseed Oil, respectively. Gas chromatography showed different concentrations of omega-3 fatty acids as (% area under the curve): flaxseed oil (32.42%), walnut oil (7.637%), anchovies (3.018%), and Paul Newman’s Marinara (1.599%). All three variant sauces, flaxseed oil, walnut oil, and anchovy, compared to the commercial Paul Newman's sauce, had better omega-3 fatty acid content and lower omega-6 to omega-3 ratio. In conclusion, simple additions of omega-3 ingredients to marinara sauce could decrease the omega-6 to omega-3 ratio in the diet.

Breastfeeding reduces morbidity and mortality among mothers and children, yet African-American women breastfeed at lower rates than women of other racial and ethnic groups do. Higher rates of overweight, obesity, and low socioeconomic status may be contributing factors in this population; however, limited research exists regarding the roles of maternal overweight and obesity on breastfeeding outcomes. The purpose of this study was to examine whether social support and self-efficacy positively influence breastfeeding outcomes among overweight and obese African American women. Self-efficacy and social support theories provided the theoretical framework for the study. Research questions examined whether (a) maternal overweight and obesity, social support, and self-efficacy were associated with breastfeeding initiation and duration among African-American women; and (b) self-efficacy mediated this association. The study design was a quantitative retrospective analysis of a subset of secondary data from the 2009-2011 Pregnancy Risk Assessment Monitoring System (n = 10,926). SPSS 21.0-® was used for analyses. Obesity was significantly associated with breastfeeding durations of 9-16 weeks and 17 or more weeks. Self-efficacy was significantly associated with breastfeeding initiation only. Social support was negatively associated with breastfeeding durations of 9-16 weeks among obese women. Positive social change implications include increased knowledge of the associations between overweight, obesity, social support, self-efficacy, and breastfeeding outcomes among African-American women. This knowledge could be used to inform the development of interventions to improve breastfeeding and weight related health outcomes.

This study aimed to implement and assess a school-based multi-component intervention aimed at increasing elementary school-aged children's knowledge of, preference for, and intake of vegetables. The multi-component intervention included lunchroom exposure, nutrition curriculum in the classroom, after school program vegetable curriculum, family friendly nutrition newsletter, vegetable fair and parent cooking class. Lunchtime vegetable consumption was assessed by direct observation. Changes in preference, attitude, and knowledge were assessed using a pre- and post-intervention survey. The multi-component intervention was implemented at Canyon Elementary during the 2008-2009 school year. Classroom teachers provided 20 minutes of nutrition education to students in grades one through five (n=450) once every month from September 2008 through May 2009. Students who participated in the after school program received additional education once a week for three weeks each month. Overall, no significant difference was observed between children's pre- and post-intervention except for their willingness to try new vegetables. Students in grades second and fourth (n=81) were asked to participate in a plate-waste study by allowing researchers to photograph the amount of vegetables they selected and consumed during (p=0.483) second and (p=0.467) fourth pre-intervention and (p=0.71) second and (p=0.34) fourth post-intervention lunch-period. No change in vegetable consumption was observed (p >0.05). Although the intervention was well received by Canyon Elementary administration, teachers, food-service director, and students, we observed not significant changes in the outcomes we assessed. The results of this study are not consistent with other multi-component school-based interventions that have effectively changed diet- related behaviors among children. Additional work in this area at this school should include additional validated outcomes assessments, changes to the selection of vegetables offered to children in school lunch menus, and a stronger parent involvement.

There is currently much interest in the comparative health benefits of various meat products, including pasture-fed beef. However, little is known about the specific pasture-finishing diets (mixed forages, alfalfa, or sainfoin, compared to grain) on meat quality, consumer preferences, and human health. Thus, additional information is needed to better understand and develop new animal feeding regimes for optimum animal growth, meat flavor, and meat nutritional quality. The objective of the current study was to examine how animal diets, including secondary metabolites in the diet, affect meat chemical characteristics, meat quality, and nutritional value. In study 1 (Chapter 3), grain- vs. pasture-fed beef rib steaks were evaluated. Ribs from pasture-fed animals had a much lower fat content (P < 0.01), which was its main positive nutritional attribute. Pasture-fed beef had more (P < 0.05) omega-3 polyunsaturated fatty acids (PUFAs) and conjugated linoleic acid (CLA) than grain-fed beef, but was only a moderately good source of PUFA, compared to salmon. Pasture-fed beef had higher antioxidant capacity and lower measures of oxidation (P < 0.05). Pasture and grain diets influenced the volatile profile of cooked meat. Flavor descriptors barny, gamey, and grassy were associated with pasture feeding, and were uniquely shown in this study to be positively correlated with specific aroma volatiles benzaldehyde, toluene, dimethyl sulfone, 3- heptanone, 2-ethyl-1-hexanol, and hexadecanoic acid methyl ester (P < 0.05). In study 2 (Chapter 4), the effects of legume pasture-finishing of beef cattle on meat quality were evaluated, comparing alfalfa pasture (containing saponins) versus sainfoin pasture (containing tannins). No strong differences (P > 0.05) were found between the two legume diets in all meat characteristics, indicating that sainfoin was similar to alfalfa as a cattle forage. Similar (P > 0.05) low TBA values after 12 d of storage at 2 °C were obtained from both diets, comparable to pasture-fed beef from study 1. This verified the prolonged retail shelf life benefit of forage-fed beef, compared to grain-fed beef. In study 3 (Chapter 5), lambs fed four different diets, plain/control (P), tanninsrich diet (T), saponins-rich diet (S), or choice of them (C), were evaluated on metabolomics profiles using GC/MS technique. Forty metabolites were detected (30 named and 10 unknown). A principal component analysis (PCA) plot showed a clear separation of P, T, and S diet treatments while the C diet was overlapped with S and P diets, indicating that S or P diets were preferred while the T diet was avoided. In summary, the effects of ruminant diets on meat characteristics depended on the type and concentration of plant secondary compounds (PSC), especially the PSC levels contained in the pastures.