Patients with liver disease have an increased risk for malnutrition because of side effects of the disease. The Nutrition Focused Physical Exam (NFPE) was developed for nutrition professionals to aid physicians in a nutrition-based diagnosis of malnutrition. The purpose of this study was to examine the NFPE for its validity in liver disease patients being evaluated for transplant. In addition, the NFPE was used to assess incidence and severity of malnutrition in end stage liver disease patients and compare these results to already developed malnutrition tools such as the Patient Generated-Subjective Global Assessment (PG-SGA), Triceps Skinfolds (TSF), Mid-Arm Circumference (MAC), Lumbar Index, and Total Psoas Muscle Area (TPA). The NFPE was found to be highly correlated with PG-SGA results. There was a weak correlation between the NFPE and the TSF, MAC, and Lumbar Index/TPA, except when comparing the bottom 25% quartile of the Lumbar Index to severe malnutrition using the NFPE. This resulted in a moderate correlation. The odds-ratio for hospital admission based on malnutrition and severe malnutrition were both extremely high (14.571, 18.857 respectively). These preliminary results reinforce the significance of the NFPE and the need for additional studies using this tool.

Objective: Measures the impact of the Farmers’ Market Voucher program on weight, body mass index, waist circumference, during the 2016 summer on a rural, low-income population residing in Appalachian Kentucky. Background: Rural communities often have limited access to fresh fruits and vegetables (FV) which contributes to low levels of consumption. FV are calorie poor, nutrient dense and are inversely associated with inflammation markers, obesity, hypertension, and high blood glucose levels. Appalachian rural communities have a higher prevalence of obesity, diabetes, strokes, and death by heart attack when compared to the U.S. Farmers’ markets Methods: Pre-experimental intervention design examining FV consumption and variety. T-test used measuring biochemical outcomes, pre and post, participation, and voucher amount. Results: Medical clinic patients (n=308) and household members (n=89) participated in study. Patients had a decrease in blood glucose and waist circumference (p=0.0231, p=0.0014 respectively). Patients had greater blood glucose reductions when compared to household members (p < 0.001). Patients reported consuming more FV with greater variety. Conclusion: The Farmers’ Market Voucher program successfully increased FV consumption and had a positive effect on blood glucose and waist circumference. Future studies should examine cooking methods of this population.

The Center for Disease Control and Prevention (CDC) reports indicate that 8% and 6.3% of Kentuckians consume enough fruits and vegetables, respectively. The Plate It Up! Kentucky Proud (PIUKP) project is a recipe-development project that aims to boost produce consumption by incorporating local fruits and vegetables. The purpose of this study was to implement promotional strategies using PIUKP recipes at farmers’ markets and determine their effects on consumers’ intent of purchasing and preparing the produce. The study was conducted at nine farmers’ markets across Kentucky (n=300) in collaboration with Cooperative Extension agents/assistants. The consumers’ impression of the sample was positively associated with their intent to purchase fruits and vegetables the same day (t = 0.36; p < 0.0001), in future (t=0.43; p < 0.0001), and prepare the respective recipes (t=0.51; p < 0.0001). Distribution of recipe cards was also positively correlated with consumers’ intent to prepare recipes (t=0.35; p < 0.0001). However, no significant association was found between the self-reported fruit and vegetable intake and their respective dermal carotenoid score. Findings from this study support the use of promotional strategies as a means to influence produce intake among farmers market consumers. Future studies can apply these strategies and explore the extent of effect they have on dietary intake.

Since 1980, the obesity rate in children 5 to 11 years of age has increased from 7% to 18%. The lack of structured physical activity and poor dietary habits childhood are primary risk factors for obesity related comorbidities in adulthood. Guided by primary care providers, families can reverse childhood obesity by implementing healthy dietary habits and engaging in structured physical activity. The purpose of this quality improvement project was to develop an evidenced-based policy with procedures to standardize the timely and consistent identification of overweight children at a primary care clinic serving military families. With an emphasis on obesity prevention within families through primary care interventions, the revised health belief model guided the project design. A literature review was conducted in a systematic manner to identify effective strategies and interventions to inform the policy development. Then, the Delphi technique guided a 12-member expert panel to evaluate the policy and procedures in terms of the level of evidence and the implementation plan with the goal of achieving consensus with recommendations for revisions. Consensus was achieved with multiple revisions following the completion of two Delphi rounds. The first panel session (n=12) concluded with a 70% consensus, including recommended revisions to improve the policy implementation. The second panel session (n=12) concluded with 100% consensus for the revised policy. The final policy and procedures addressed the clinical practice gap with a robust process to identify, counsel, and refer overweight children to external specialty programs for obesity management. By intervening to reverse the progression of childhood obesity, this project achieved positive social change at an organization level.

Improving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improving nutritional status. ONS use has been associated with improved outcomes among patients with diagnoses of orthopedic injuries and pressure ulcers, mainly using prospective designs among elderly and/or malnourished patients. Less information is available for other diagnoses, and no analysis of the effects of ONS could be found that considered the epidemiological triad of person, place, and time. This study used a quantitative, retrospective design to examine whether routine ONS use was associated with hospital length of stay (LOS) among 570 adult inpatients at a regional medical center diagnosed with heart failure, adjusting for significant personal, locational, and time variables. It was unique in the inclusion of epidemiological triad variables. Using multiple logistic regression to control for covariates, ONS use was associated with higher LOS in this sample (odds ratio=2.43). High LOS was also associated with higher Charlson Comorbidity Index (CCI) values, discharge destination, White ethnicity, female gender, and hospital room location. This study is expected to contribute to positive social change by helping inform hospital staff on factors affecting patient outcomes and LOS, and highlighting the need for continued research on interventions to improve care in hospitals.

Undocumented end stage renal disease (ESRD) patients in the United States only have access to emergency dialysis. To compensate for the lack of regular dialysis these patients must follow strict renal dietary restrictions. However, nutrition counseling by a dietitian is not part of the renal management of patients on emergency dialysis. The purpose of this quantitative quasi-experimental treatment-control study was to assess how the application of nutritional counseling that is both culturally and linguistically competent affects dialysis frequency and biochemical lab values such as serum potassium, phosphorus, and vitamin D of patients in emergency dialysis. The study was grounded on the social cognitive theory and consisted of a secondary data analysis of information collected from electronic medical records. The sample size consisted of 96 emergency dialysis patients, 51 from the intervention group, and 45 from the control group. Results from Quade's test revealed there is statistically significant difference in serum levels of phosphorus [F(1,94) = 9.616, p = 0.003] and levels of Vitamin D [F(1,94) = 51.411, p = .000] between the intervention and control groups, controlling for age, gender, and time on dialysis. These findings suggest the implementation of nutrition counseling that is both culturally and linguistically competent can improve phosphorous and vitamin D levels among emergency dialysis patients. The potential social change implication of this study is that its findings may serve to assist health care professionals to design and implement interventions to improve the health status of emergency dialysis patients and reduce their impact on the public health system.

The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of viral suppression, retention in care, and CD4 counts. The behavioral model for vulnerable populations was used as the theoretical foundation for this quantitative cross-sectional study. A sample of 428 RWHAP clients was used from the Ryan White Services Report data. Pearson's chi-square was used to examine the association between medical nutrition therapy (MNT) and viral suppression. Findings indicated statistically significant associations between MNT and viral suppression, retention in care and any nutrition service (food assistance, MNT, or both), and MNT and retention in care. Implications for social change include emphasizing the role of nutrition services in HIV-related health outcomes for PLWH in resource rich areas.

Due to increased rates of childhood obesity since 2010, researchers have examined family environmental factors and family influences on children's consumption of healthy foods. While previous research has examined how factors such as food presentation and the food intake of other family members can predict a child's body mass index, there has been little research examining whether parent factors predict the amount of healthy foods children eat. This quantitative survey study examined whether certain parent factors, specifically parents' attitudes about food, parents' feeding styles, and parents' attachment styles, predicted the amount of fruits and vegetables children ate. Understanding the extent to which these factors predict children's actual consumption of healthy foods, rather than predicting their body mass index, will further inform the healthcare field about parents' role in their children's physical development. Family systems theory served as the theoretical foundation. Seventy-four parents of children ages 1 to 7 years completed an online survey containing items from the Caregiver Feeding Styles Questionnaire, the Relationship Structures Attachment Questionnaire, and the Parent Attitudes About Food Questionnaire. As well, they logged the amount of fruits and vegetables their child ate over a 1-week period. The results of the multiple regression analysis revealed an overall significance which suggested that the 3 parent factors together predicted the amount of fruits and vegetables that children ate; however, closer examination indicated that only parents' attachment style was a significant prediction of children's consumption of fruits and vegetables. The results of the study add to our understanding of the role that parents play in their children's eating habits and the influence of attachment on children's consumption of a nutrient-dense diet.

In Ethiopia, 17% of pregnant women ages 18-49 are malnourished and have low awareness of prenatal nutrition, which may relate to increasingly high rates of maternal and infant mortality. The purpose of this mixed methods research study was to determine the effects of a community-based prenatal nutrition education intervention program on maternal nutrition knowledge and attitudes in the Alaje district of Ethiopia. The theoretical framework was Sen's capability theory of poverty, in which opportunities can lead to well-being and promote economic development. Research questions focused on the relationships among 8 independent variables-age, income source, degree of program implementation, marital status, education, number of pregnancies, number of children, and occupation-with respect to maternal nutrition knowledge and attitudes. Health workers recruited 135 pregnant and non-pregnant women in each of 2 villages: Dejen (control village) and Takha (experimental village), totaling 270 participants. The community intervention program was an add-on to the Ethiopian government's nutrition program and provided information on portion sizes, the importance of eating an extra meal each day, and obtaining adequate rest during pregnancy. Data from customized pretest and posttest focus groups and surveys were collected. Focus groups were analyzed manually and surveys were analyzed using 1-way ANOVAs and descriptive statistical analyses. The key findings were that the women in Takha had significantly greater knowledge of the importance of prenatal health requirements. The implications for positive social change include recommendations for policy makers about proper dietary practices in order to improve pregnancy outcomes related to maternal malnutrition.

This study was conducted to assess the effect of nutrition education utilizing computerized dietary analysis on nutrition knowledge, dietary compliance, nutrition status, and quality of life in hemodialysis patients. Twenty patients of the Bonneville Dialysis Center in Ogden, Utah voluntarily agreed to participate in this six-month study. All participants completed quality of life assessments, the Beck Depression Inventory© (BDI), and a nutrition knowledge assessment pre- and post-study. Patients in the treatment group (n=12) completed monthly 3-day food records which were analyzed by Computrition® nutrient analysis software. Results were discussed with the patients during one-on-one education sessions. Control patients (n=8) completed 3-day food records pre- and poststudy. Monitoring parameters included: nutrition-related laboratory data, kinetic modeling data, weights, and percent body fat, using Futrex® near infrared interactance. Dietary components followed were: protein, calories, sodium, potassium, calcium, and phosphorus. Multivariant analysis of variance was used for statistical comparisons. Weight and percent body fat were relatively stable throughout the study period for both groups. The treatment group's nutrition knowledge improved as measured by pre- and post-study test scores. Nutrient intakes showed no significant changes except for calorie intake, which decreased in the treatment group. The treatment group's intake of other analyzed nutrients showed declining trends, which were not statistically significant. Serum albumin and total protein increased in both groups. Average serum cholesterol levels decreased in the treatment group. Serum potassium levels did not change significantly. Serum phosphorus increased in the treatment group. However, this did not appear to be caused by increased dietary phosphorus intake. Kinetic modeling data showed a significant increase in protein catabolic rate of experimental subjects. Protein catabolic rates (PCR) are an indicator of dietary protein intakes in maintenance hemodialysis patients. The treatment group showed improvement in the alertness behavior area of the Sickness Impact Profile© (SIP). The control group declined in the recreation and pastimes area of the SIP. No significant changes were observed in the BDI. These results indicate that computerized dietary analysis is an effective instruction tool, is helpful in improving dietary protein intake as measured by PCR, and may contribute to improved quality of life of hemodialysis patients.