Background: Hospital malnutrition is a prevalent issue with critically ill pediatric patients being at increased risk for nutritional loss. Nutritional risk screening has been associated with increased documentation of nutrition diagnosis and positive clinical outcomes, however, is not mandatory in developing countries. A nutrition screening tool that uses subjective examination of loss of subcutaneous fat and muscle tissue may be an efficient way to identify nutritional risk in hospitalized critical care pediatric patients. Objective: To determine whether loss of subcutaneous fat and muscle tissue in specific body locations was associated with moderate or severe malnutrition determined by SGA in pediatric critical care hospital units, and if loss of subcutaneous fat and muscle tissue differs by gender, age, or disease. Methods: Pediatric in-patients (n = 203), aged 1 month to 18 years old, in tuberculosis, burn, oncology, high dependency (HDU) and intensive care units (ICU) in two tertiary hospitals in Malawi were assessed for nutritional status using Subjective Global Assessment (SGA), Mid-upper arm circumference (MUAC), and weight for age Z-score (WAZ). The SGA form included four questions on weight, appetite, tolerance to food and fluids, and dietary intake, as well as a nutrition-focused physical exam. The nutrition-focused physical exam consisted of assessments of subcutaneous fat loss in two locations (below the eye, triceps/biceps) and eight locations for muscle tissue loss (temple, clavicle, shoulder, scapula, interosseous, knee, quadriceps, and calf). The analysis was focused on the assessment of loss of subcutaneous fat and muscle tissue in relation to malnutrition score determined by SGA. Results: The mean age and standard deviation of the study population was 5.32 years ± 4.80, with just over 55% of participants being male. Determined by SGA, moderate malnutrition prevalence was 70.9% and severe malnutrition prevalence was 13.8%. SGA alone identified more malnutrition (84.7%) than MUAC (20.5%) and WAZ (43%). Patients with cancer (100%) and organ-related disease (93.76%) had the highest rates of moderate and severe malnutrition. Loss of subcutaneous fat and muscle tissue in all body locations assessed were associated with moderate and severe malnutrition (p-value Conclusions: A nutritional screening tool that is efficient, valid, and allows for the screening of a large patient population in a short amount of time, is needed in Malawi. Although loss of subcutaneous fat and muscle tissue were significantly associated with moderate and severe malnutrition, moderate loss of muscle tissue in the quadriceps and calf had the highest odds of malnutrition. These results indicate that pediatric patients with moderate loss of muscle tissue in their quadriceps and calf should be treated with a high index of suspicion for malnutrition. While loss of subcutaneous fat and muscle were not significantly worse by gender, age, or disease, particular attention should be paid in patients of the male sex, aged 6 to 10 years old, and with cancer. These findings support increasing dietetic services to prevent and treat hospital malnutrition using simple screening tools, such as the one used in this sub-analysis.

Despite the known importance of body composition in relation to performance and health of athletes, this study appears to be the first, or one of very few, to evaluate body composition measures from the beginning to end of season for NCAA DI collegiate baseball players and assess their dietary intake. Baseball players from the 2015-2019 seasons were included in the study (n=78; age=19.8±1.28). DXA scans performed at the start and end of season were analyzed and 3-day food records analyzed via ESHA software were utilized to assess dietary intake. Groups were stratified to examine differences in players’ positions (Pitchers vs. Position Players) and first-year status effects (Freshman/Transfer vs. Sophomore/Junior/Seniors). Based on the study’s findings, body mass and lean body mass significantly decreased from the beginning to end of season for the overall team (p= 0.002; 0.026). Position Players exhibited a significant decline in body mass, region percent fat, and fat mass (p=0.00, 0.014, and 0.021, respectively) while Pitchers did not demonstrate any significant changes. First-year players experienced an increase in visceral adipose tissue volume and visceral adipose tissue mass (p= 0.004, 0.004) and Sophomore/Junior/Seniors group experienced a significant decrease in body mass, region % fat, and fat mass from the beginning to end of season (p=0.00, 0.017, and 0.023, respectively). The team on average consumed 6% less than the recommended value for protein, 36% less than recommendation for carbohydrate and 10% above the recommended intake amount was determined for fat. Overall, the team consumed 18% less than their estimated total calorie recommended goal. We believe the study presents interesting findings that may be helpful for collegiate baseball programs, and potentially athletes in similar sports, to improve the performance, development and health of young student athletes.

Body fat distribution has been identified as a more significant risk factor for metabolic-related diseases. This study investigated whether body fat distribution affects dietary outcomes (quality and intake), anthropometric measures, body composition, and skin carotenoid levels. A cross-sectional study with 91 female students was conducted. Thirty-one percent of participants (n=28) had an android body fat distribution. Body fat distribution was associated with WC and WHtR (p

Breastfeeding rates in America are lower than other high-income countries, with Mississippi having one of the lowest rates. A survey using the Iowa Infant Feeding Attitude Scale (IIFAS) was distributed twice to Mississippi State University students to understand their breastfeeding attitudes. Attitudes were determined by calculating a composite score and conducting statistical tests for significance. Knowledge between health and non-health related majors were explored by using five statements, and attitudes towards the statement “Breastmilk is the ideal food for babies” were compared across demographics. Of 642 respondents, the composite score was 57.3 out of 85, and all demographics had a neutral score (between 49-69). All demographics agreed that “Breastmilk is the ideal food for babies” and health (46.1%) and non-health related majors (53%) had similar knowledge towards breastfeeding. College students may become parents, so understanding their attitudes can provide insight into their feeding methods and educational needs.

Background: The importance of nutrition on athletic performance is evident. Athletic trainers (ATs), nutritionists/RDs, strength and conditioning specialists (SCSs), and other athletic department personnel may be available to student-athletes and can be solicited for nutrition advice. Multiple studies have found that although some universities have a sports nutritionist on staff, student-athletes approached an AT most often for nutrition advice rather than an SCS, nutritionist or other person. ATs have the necessary education to provide proper nutrition information to student-athletes; however, it is not the primary role of an AT. Objective: The purpose of this study was to examine the quantity, quality and variety of nutrition support offered to Division I student-athletes who participate in football. Additionally, the purpose was to gain the perspective of the AT with regard to their role in educating football players on basic nutrition principles. Design: Cross sectional. Setting: Participants completed a web-based questionnaire. Patients or Other Participants: 253 Division I institutions were identified; from those institutions 120 head ATs were randomly chosen to receive the questionnaire. Responses from 30 (25%) head ATs (Football Bowl Subdivision 53.6%; Football Championship Subdivision 46.4%) were analyzed. Results: A majority (69%, n=20) of the institutions provided access to a nutritionist/RD. When asked who they believed student-athletes would solicit nutritional advice from first, respondents ranked their answers as follows: AT (n=11, 36.7%), SCS (n=10, 33.3%), nutritionist/RD (n=7, 23.3%), and coach (n=2, 6.7%). However, in the Likert scale questions, participants felt between neutral and slight agreement regarding their own responsibility, or that overall, ATs should feel responsible to teach nutrition or promote proper eating habits. In another question, participants were asked who is responsible for educating football players about nutrition at their institution and were able to select more than one response. Participants felt that all three professionals had a fairly high level of responsibility (SCS n=26, 86.7%; AT n=23, 76.7%; nutritionist/RD n=21, 70%). ATs ranked their perception of who helped with management of specific medical issues as follows: AT (n=26, 86.7%), nutritionist/RD (n=21, 70%), physician (n=18, 60%), and SCS (n=3, 10%). FBS institutions seem to provide more nutrition services compared to FCS institutions; 73.7% of FBS institutions are providing access to a nutritionist/RD and whereas only 26.5% of FCS institution provide this service. Conclusions: ATs from our study strongly agreed that nutrition plays an important role in performance. As shown in previous studies, ATs and SCSs were found to be the primary sources of nutrition information for student-athletes in Division I settings. This study gathered the AT’s perspective and perceived roles regarding where student-athletes receive nutrition information from most often. The ATs in this study confirmed that they felt the ATs and SCSs were primarily approached for nutrition advice. Although these ATs responded that the SCSs, ATs, and nutritionist/RDs were all responsible to educate football players at their institutions, the ATs answers were conflicting when they said that they did not feel the ATs role should be responsible for educating football players on nutrition and performance. Because ATs did perceive themselves as qualified, it is suggested that they may feel another professional of the sports medicine team is more appropriate to fill this role. A sports medicine team consisting of ATs, SCSs, nutritionists/RDs and physicians should work together to promote the benefits of nutrition and provide optimal services within their professional scope of their practice. In the absence of one or more professional, effective knowledge and communication must be maintained to assure that the roles of nutrition services are still provided to football players.

Cardiac disease is the primary cause of death in the United States of America (CDC, 2017). Despite ongoing efforts and investments to improve cardiac health in the United States, most of the population will suffer from cardiovascular diseases. There is a multitude of research supporting that diet can contribute to cardiac disease, but it is less known that diet can greatly contribute to regulation and reversal of cardiovascular disease processes (Huang et al., 2012; Satija et al., 2017; Kim et al., 2019). Existing research supports the efficacy of plant-based diets to manage and reverse certain cardiac diseases (Tuso et al., 2015; Esselstyn, 1999; Ornish 1998; Campbell et al., 1998). Plant-based diets have the potential to save many lives and drastically reduce healthcare costs. The purpose of this literature review is to evaluate current research on plant-based diets as interventions for cardiac disease and to identify the reasoning for underutilization of plant-based diets as intervention with cardiac health within the United States population. A database search of CINAHL Plus, MEDLINE, BIOSIS, Cochrane, Google Scholar, and PubMED was conducted and university librarians were utilized. Inclusive criteria and keyword searches were comprised of coronary artery disease and plant-based diets, cardiac disease and diet interventions, intensive lifestyle changes for reversal of coronary heart disease, plant-based diets and cardiac disease and inflammation, and plant-based diets reducing cardiac inflammation.

Background - Type 2 Diabetes Mellitus (T2DM) is a growing crisis that can lead to more problems if left untreated. One of these problems includes diabetic nephropathy or Chronic Kidney Disease (CKD). While there have been many advances in the field of treating CKD with medication, there are currently no medications with the capability of stopping the progression of or reversing diabetic nephropathy; however, recent studies have shown that diabetic nephropathy can be stopped and even reversed through dietary interventions. One of these studies went through the effects of a low protein diet on diabetic nephropathy and found very promising results. This meta-analysis was designed to explore the effects of a Low Carbohydrate Diet (LCD) on diabetic nephropathy. Methods - An electronic search of PubMed and Google Scholar was conducted. To be considered eligible the studies had to contain (‘carbohydrate’ OR ‘carbohydrates’) AND (‘diet’ OR ‘diets’) AND (‘type 2’) AND (‘diabetes’ OR ‘diabetic’) AND (‘ketogenic’). The studies also had to measure Estimated Glomerular Filtration Rate (eGFR) and Glycated Hemoglobin (HbA1c). Statistics and calculations were performed by Review Manager version 5.3 while risk of bias was assessed using the Robvis ‘risk of bias’ tool. Findings - 262 potential articles were identified by the search and 10 studies matched the search criteria with a total of 921 participants (450 were given the LCD and 471 were given control diets). Analysis of the total Standardized Mean Difference (SMD) for the eGFR studies showed that there was no difference between the LCD and the control (total SMD: -0.00; 95% CI, -0.20 to 0.19; P = 0.97). Analysis of the serum creatinine showed similar results (SMD: 0.13; 95% CI, -0.12 to 0.38; P = 0.31). The total SMD for the HbA1c (SMD: -0.29; 95% CI, -0.55 to -0.03; P = 0.03) showed that there was a lowering of the HbA1c in the LCD and not in the control diet. Conclusion - In this meta-analysis there was no connection found between eGFR/serum creatinine and percent carbohydrates in the diets indicating the LCD did not negatively affect the kidneys. HbA1c was found to be lower in the LCD than in the control which points to a LCD possibly leading to the reversal of T2DM which would remove the main cause of diabetic nephropathy.

Although breakfast programs in schools have been encouraged in school-aged children due to numerous benefits on physical and academic performance, participation in School Breakfast Programs (SBP) remains lower than the National School Lunch Program in the United States. Some studies have found that lower participation in the SBP are due to barriers and stigmas. Some studies have found that when breakfast programs are taken into the classroom, uptake of the program improves. However, the relationship between breakfast intake and academic outcomes among young adolescents remains inconclusive. The goal of this study was to examine the effect of a newly implemented Breakfast in the Classroom (BIC) program within a large urban school district in Western Massachusetts. A secondary comparative cross-sectional analysis was conducted to investigate the impact of the “Breakfast in the Classroom” (BIC) program on middle school students’ academic performance, absenteeism rates, and school nurse visits, factors that influence learners positive experience within the school system. Data on a total of 1,897 students from seven public schools in Western Massachusetts were included in the analysis. Linear regression models showed that breakfast in the classroom (BIC) program did not have a significant effect on student academic performance, attendance, and school nurse visits in a cohort of middle school students. Sensitivity analysis on a subset of the sample of students receiving free lunch who are also participants of the BIC program, had significantly higher academic performance outcomes than their BIC peers who were ineligible for the free lunch program. Findings of the study provide important baseline data for both food services and the school board district and can help inform future studies on the impact of the BIC program on student outcomes.

Relevance: Heart disease is the leading cause of death worldwide. Observational and experimental evidence has shown that fruits high in polyphenols can reduce morbidity and mortality of heart disease. Introduction: This systematic review meta-analysis was conducted to evaluate the current evidence for anthocyanin-rich fruit supplementation amelioration of hypertension. Methods: Articles were identified, collected, screened, then data were analyzed via CMAv.2 for overall effect on blood pressure, nitric oxide, flow mediated dilation and pulse wave velocity. Results: The analysis showed a small, significant effect on diastolic blood pressure. No moderator groups had significant effects, though some individual subcategories showed significant effects. Conclusion: Diastolic blood pressure in humans can be beneficially influenced by consumption of anthocyanin-rich fruit.

Purpose: The study aims to assess the Quality of Life (QoL) among patients undergoing semaglutide treatment for weight loss. The primary hypothesis is that patients’ QoL will improve after semaglutide treatment. This can be due to losing weight, having better physical and mental health, or due to the perceived betterment in life after treatment. Introduction: Obesity is becoming more prevalent in America, and it has a huge effect on the person's medical conditions, life expectancy, and QoL. Though there has been a surge of treatments to deter the obesity rates in America from rising. One of the more popular and recent treatments is the usage of semaglutide also known as Wegovy, a Glucagon-like peptide-1 (GLP-1) receptor agonist to help decrease weight. Semaglutide was first intended to be used as a treatment for Type 2 Diabetes, but its weight loss side effects have made it an FDA-approved medication for weight loss (FDA, 2021). Methods: This study utilized clinical data and survey responses from patients who are receiving semaglutide treatment at a local weight loss clinic. Clinical data included body fat percentage, initial weight, changes in weight through the course of treatment, and Body Mass Index (BMI). A paper format survey was given to patients at the clinic, and it included a standardized questionnaire (SF-12) to measure the QoL as well as demographic questions. The SF-12 survey includes 2 domains, a Physical Component Summary (PCS) and a Mental Component Summary (MCS) scores that range from 0 to 100, where 100 represents the highest QoL. The overall QoL score is the average of both PCS and MCS scores. Collected data was downloaded and analyzed using Statistical Package for the Social Sciences (SPSS) software. The study was approved by UCF IRB and the local weight loss clinic. 1 Results: A total of 20 participants completed the survey and their clinical data was recorded. Collected data was analyzed to assess for potential changes in QoL before and after semaglutide treatment. Overall, the average weight loss for all participants was 14.75 pounds. The mean SF-12 score was 83.40 and the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were 85.63 and 81.12 respectively. When comparing QoL before and after treatment, 55% of participants reported that their overall QoL before starting semaglutide treatment was worse than now. In response to the question about the reason for selecting semaglutide for weight loss, 95% of participants chose semaglutide to lose weight faster and to look/feel better. Conclusion: No association was found between using semaglutide for weight loss and improvement in QoL.