Iron deficiency anemia is the most common nutritional deficiency disease worldwide (Mahan & Escott-Stump, 2004). Iron deficiency anemia is of major concern especially in women of child bearing age and those who follow a vegetarian diet. The objective of this study was to compare the nutrient and hematological values related to iron status in female university students following a vegetarian versus following a nonvegetarian diet. This study took a cross sectional analysis of 39 female students at California Polytechnic State University (Cal Poly State University) in San Luis Obispo, CA. Of the participants 19 were following a vegetarian diet and 20 were following a nonvegetarian diet. To participate, individuals had to be female, current Cal Poly students, and between the ages of 18 and 22 years old. Those taking vitamin or mineral supplements, medications (including oral contraceptives), smokers, and pregnant women were excluded. Characteristic, demographic, and anthropometric data were collected through interview, nutrient intake was accessed by averaging three day food records, and hematological parameters were measured. Statistical analysis used nonparametric techniques including the Mann-Whitney Wilcoxon statistical test for demographics and baseline characteristics, the Spearman Rank Correlation analysis and Fisher’s Exact statistical test for associations between vegetarians and nonvegetarians. Results found no significant difference in iron intake between vegetarians and nonvegetarians, however nonvegetarians had higher mean intakes of iron at 16.82 (SD 6.36) mg/day compared to vegetarians at 14.84 (SD 7.10) mg/day (p=0.482). A similar percentage of vegetarians at 66.7% (n=8) compared to nonvegetarians at 65% (n=13) were under the Recommended Daily Allowance (18 mg per day for females 19 to 30 years of age) for mean iron consumption. There were slightly more nonvegetarians at 10% (n=2) compared to vegetarians at 8.3% (n=1) under the Estimated Average Requirement (8.1 mg/day for females 19 to 30 years of age) for mean iron intake. No significant difference was found for serum iron, serum ferritin, transferrin saturation, and total iron binding capacity between vegetarians and nonvegetarians. Finding revealed serum ferritin, the most common iron status indicator, was lower for vegetarians at 23.16 (SD15.54) ng/mL compared to nonvegetarians at 27.75 (SD 18.01) ng/mL (p=0.47). When looking at the stages of iron balance, there was greater percentage of vegetarians with hematological results (serum iron <40 µg/dL, total iron binging capacity of >410 µg/dL, transferrin saturation <15%, and serum ferritin <10 ng/mL) indicating iron deficiency anemia or stage IV negative iron balance compared to nonvegetarians. There was no significant correlation between iron intake and serum ferritin, however results showed a positive association (r=0.28, p=0.09). In conclusion, vegetarian participants are believed to be at higher risk of developing negative iron balance compared to nonvegetarians due to lower iron consumption and lower serum ferritin concentrations. Female university students following a vegetarian diet should be educated on iron deficiency anemia and prevention of iron depletion.

The purpose of this study was to identify specific nutrients or nutritional biomarkers of dietary intake that are associated with stunting among children ages 2 and older in sub-Saharan Africa. This is a systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twelve studies from sub-Saharan Africa met the eligibility criteria, including 11 observational studies and one randomized control trial. Nine of the 12 studies assessed dietary intake of macronutrients. Four studies found a significant association between proteins and stunting. Four found that children with stunting had lower dietary fat intakes or lower blood or serum levels of certain fatty acids. Five assessed dietary intake of micronutrients or looked at serum levels micronutrients. Children with stunting had lower intakes or biomarkers for, calcium, phosphorous, vitamin D, vitamin B12, and choline. Children with stunting tend to consume diets lower in nutrients of high-quality protein foods like essential amino acids, essential fatty acids, and micronutrients such as calcium, phosphorous, vitamin D, vitamin B12, and choline.

Inflammation is a complex physiological response normally initiated by the innate immune system, often as a response to exposure to otherwise harmful stimuli. While generally useful in humans as a protective response to foreign matter, chronically elevated quantities of associated inflammatory factors C-reactive protein, TNF-alpha, IL-6, and IL-1beta have been linked in literature with decreased overall lifespan and well-being in humans via inflammatory processes. It is possible that by lowering these associated factors, increased well-being and lifespan may be experienced by the general population. One common health supplement with such promise is fish oil, which, through compounds eicosapentaenoic acid and docosahexaenoic acid, has been observed to decrease levels of secreted inflammatory markers in cell culture. In addition, molecular pathways have since been discovered which demonstrate possible means for which this physiological response may occur. However, despite the promise of such health benefits, studies attempting to discern the impact EPA/DHA supplementation has on inflammatory markers within humans have since emerged with mixed results. The aim of this study is to provide a meta-analysis across a number of studies to determine whether or not an impact exists through EPA/DHA supplementation in healthy populations, and if one exists, to what degree the respective inflammatory factors may be lowered.

Food insecurity is prevalent in the United States. Although older adults experience food insecurity at lower-than-average rates, this population is vulnerable to the nutrition and health related implications. Food insecurity is tied to both a diminishment of diet quantity and quality, and is associated with incidence of chronic disease, loss of functional status, and quality of life. This survey seeks to fill a gap in research by looking into the prevalence of food insecurity among older adults in Northeast Tennessee, associations between food insecurity and self-rated health, and associations between food insecurity and geographical limitations.

The aim of the present study was to determine the effect of vitamin D supplementation (4000 IU or 6000 IU of cholecalciferol daily for 6 months) on fasting plasma glucose, fasting insulin, glycated hemoglobin, and lipid profile in a sample of African-Americans and Hispanics with T2D and vitamin D insufficiency. Seventy five participants were recruited by community outreach. Plasma glucose concentration was measured by hexokinase enzymatic method. Glycated hemoglobin was measured by the DCA2000+ system. Insulin in fasting blood was determined by radioimmunoassay. Plasma total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein cholesterol were assayed by enzymatic methods. Serum vitamin D concentrations were measured with an enzyme-immunoassay kit. Mixed model was used to compare treatment effects and Bonferroni multiple comparison tests was used to detect significant changes from baseline, 3 months, and 6 months on the outcome variables. Significant improvements in serum 25(OH)D levels were seen from baseline to 3 month and 6 months respectively in both treatments (from 22.25 ± 7.19 to 37.34 ± 12.31 and 37.99 ± 13.22, PPP=0.040) was observed. Similarly, a significant change in serum triglycerides was observed at 6 months in the 6000 IU group (from 201.44 ± 91.35 to 172.92 ± 76.87 mg/dl, P=0.037). However, when the model was adjusted for confounders, significance was lost. Vitamin D supplementation did not improve glucose homeostasis in this sample. The positive effect of vitamin D supplementation on lipid profile may be mediated by other cofactors related to vitamin D metabolism.

A goal of schools is to provide students with practical nutritional information that will foster healthy lifelong behaviors. Unfortunately, students at one school were found to have difficulty grasping basic nutritional information and practical health-related skills. There remains an important gap in current literature regarding strategies to improve students' understanding of nutrition education material. The purpose of this study was to investigate the benefits of a 4-week nutrition intervention unit in the Foods I classes consisting of 82 male and female students in Grades 9-12. Constructivist teaching methods were implemented to provide students with both information and valuable skills, which might positively impact student health and student learning. A pre-experimental quantitative design was used for this study. The repeated-measures t test was used to compute differences in pre- and post-tests scores on the nutrition test, which indicated a 6.207 mean increase in student posttest scores. The 82 students also completed a Likert style survey, which indicated both a positive student result in perceiving a better understanding of nutrition knowledge, and a positive change in dietary choices due to constructivist teaching strategies used in the intervention. These results revealed the benefits of the nutrition intervention unit by the significant increase in students' nutrition knowledge and students' implementation of that knowledge in daily living. The results make an important contribution to the existing literature and can enhance social change initiatives through increasing students' knowledge of nutrition, providing them with life-based skills, and enhancing their quality of life.

In the past 30 years, binge eating and obesity has increased among all age groups due to lifestyle, environment, social, and biological reasons. To change eating habits, individuals may have to collaborate with others beyond the medical professional. Societal impacts of binge eating and obesity include increases in insurance rates, medical costs, and increased early-age mortality. The purposes of this study were to assess how individuals are referred to other professionals if they self-identify as binge eaters or obese and to understand personal awareness individuals had of binge eating and obesity. Cognitive behavioral theory was used as the theoretical foundation. A quantitative, non experimental design was used with a nonrandom convenience sampling of residents in a northern US state aged 18 years and older. 166 participants completed a demographic questionnaire and the Eating Attitudes Test (EAT-26). Chi square analyses indicated a significant relationship between individuals who were obese and the lack of referral to another professional beyond the primary care physician. Individuals over identified with binge eating based on elevated EAT-26 scores, and under identified with obesity based on identifying with lower BMI categories than those set by the American Medical Association. Implications for positive social change include an increased awareness of binge eating and obesity, which can result in reduced medical costs and healthier lifestyles. Prevention and intervention programs can be developed to educate children, parents, and communities about lifestyle choices.

Lack of fruit and vegetable (FV) consumption is directly linked to the prevalence of obesity and chronic disease in the United States. The USDA Fresh Fruit and Vegetable Program (FFVP) offers elementary school teachers access to healthy foods as part of the public school classroom experience. The purpose of this study---which was based on self-efficacy theory and the socio-ecological model---was to examine if an association exists between selected factors: (a) daily fruit and vegetable consumption, training status in the USDA Fresh Fruit and Vegetable Program (FFVP), and an established school nutrition policy and (b) nutrition-teaching self-efficacy (NTSE) among elementary school teachers who participated in the FFVP. Using an online survey, 66 teachers out of 114 (58% response rate) completed a 26-question survey adapted from the Nutrition-Teaching Self-Efficacy Scale and the National Cancer Institute's Food Attitude and Behavior Survey. Based on the results of the chi-square test of association (p = 0.031), an association between daily FV intake and NTSE among teachers involved in the USDA FFVP was confirmed. The odds of having high NTSE are 3.45 higher in those who consume more than 3 cups of combined FV each day (p = 0.029). There were no significant associations between NTSE and FFVP training and established school nutrition policy. The social change implication of this study is that healthier, confident teachers build healthier school environments and create the impetus for increasing FV consumption in the community at large, thereby helping to reduce the risk of obesity and chronic diseases.

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important. The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using a Theory of Planned Behavior (TPB) framework, the influences on mothers’ toddler feeding decisions. These included attitude, subjective norms, and perceived behavioral control. These constructs were derived from discussions about what sources of nutrition information mothers use and trust. The aim of the subsequent study was to use the TPB to assess factors affecting a mother’s behavioral intention to provide their toddler with a healthy diet and to see if the addition of the parental role construction variable strengthened the TPB’s ability to significantly predict the mother’s behavioral intention. The first study used a qualitative approach to gather data from three focus groups that consisted of mothers of toddlers (N = 15). Qualitative thematic analysis was used to define prominent themes. Four major themes emerged from the data analysis: (1) attitudes (subthemes: positive towards maternal role of feeding and negative towards the maternal role of feeding); (2) subjective norms positively accepted (subthemes: social media, pediatricians, and registered dietitians); (3) subjective norms negatively accepted (subthemes: pediatricians and registered dietitians); (4) perceived behavioral control (subthemes: acceptance, scarcity of time and outside influences). An online survey was created using data gathered from the focus groups and a previously validated survey that fit the theoretical basis of the study. The survey utilized the TPB to assess the connections between the constructs and the mothers’ behavioral intentions surrounding toddler feeding. The final sample consisted of 148 mothers. The mean age was 32.83 (SD = 6.16) years. The majority of participants were married (87.2%), had earned a college degree or higher (79.7%), held part-time or fulltime employment, (60.8%), and were White (90.3%). The TPB model predicted 53% of the variance in mother’s behavioral intention surrounding the behavior of providing meals that include a wide variety of the five food groups in appropriate amounts. The addition of the parental role construction variable added 6% more predictive power to the model. The most salient predictors included attitude, perceived behavioral control, and parental role construction. Mothers positively and negatively receive information from a variety of sources, they have many strong emotions associated with feeding that are deeply rooted in their roles as mothers, and their feeding decisions were strongly influenced by the TPB constructs. Health promotion efforts should aim to increase the mother’s sense of behavioral control and parental responsibility rather than focusing on the benefits of healthy eating. Programs should provide tangible ways to help mothers overcome perceived barriers and, in turn, increase mothers’ beliefs in their ability to provide toddlers with a balanced diet.

Rural Appalachian populations have greater rates of obesity and chronic diseases attributed to lesser consumption of fruits and vegetables (F/V) and physical inactivity. Barriers to F/V consumption and physical activity include poor access and affordability. To help overcome these barriers, a community-initiated walking and farmers market F/V voucher program was implemented. Participants were encouraged to walk (1.2 miles roundtrip) to the local farmers market to redeem a $10 voucher which could only be spent on F/V. The 16-week program (June – Sept) included 121 participants. Data was analyzed by creating two groups, low-engagers and high-engagers that differed significantly in the number of times walked to the market and redeemed vouchers, p ≤ 0.0001. Among all participants’ significant decreases were seen in total cholesterol, LDL, ratio of total cholesterol/HDL cholesterol, 10-year risk of heart disease or stroke score, and hemoglobin A1c (p ≤ 0.05). Significant increases were seen in HDL, quantity and variety of F/V consumption among all participants and the high-engagers group. There were improvements in knowledge pertaining to participants’ awareness of the term “phytonutrient” with correctly identifying plant-based foods as the source (p=0.01). Results demonstrate that a community-based walking and farmers market F/V voucher program can improve health in a Rural Appalachian population.