The present study examined the relationship between the variables weight status (expected weight, at-risk for overweight, and overweight), ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors among adolescents. Data presented in this study were collected using the Nutrition and Exercise Survey for Students, which was completed by 535 6th grade and 9th grade students across 3 middle and 2 high-schools in southwest Florida. Multivariate analysis of variance (MANOVA) was used to identify differences in dietary intake and physical activity behaviors between groups. The primary questions related to interactions and main effects between the variables weight category, ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors. Weight category was determined by computing each participant's body mass index percentile (BMI = weight in kilograms/height in meters2). The findings of this study indicate that there are group differences in dietary intake behaviors among 6th graders and physical activity behaviors among 6th and 9th grade participants. With respect to dietary intake behaviors, an interaction was observed for gender and ethnicity, and main effects were observed for weight category and gender. Follow-up univariate F-tests were significant for weight category on meat/beans and junk food consumption; and gender differences on meat/beans consumption. All obtained effect sizes were small. For physical activity behaviors, a main effect was observed for gender among 6th grade participants and interaction was observed for gender and ethnicity among 9th grade participants. The follow-up univariate F-tests were significant for gender differences on total and vigorous activity behaviors (males had higher means than females) and small effect sizes were observed. The follow-up univariate F-tests for the gender and ethnicity interaction were not significant. Implications for the field of school psychology are discussed within the primary, secondary, and tertiary prevention model. Within this framework, a discussion of how school psychologists can assist in creating environments that encourage health-supporting behaviors at the individual and school-wide levels will be presented. Further, the need for school psychologists to collaborate with other health professionals to address overweight and some of its physical and mental health consequences is provided.

The present study examined the relationship between the variables weight status (expected weight, overweight), ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors among adolescents. The data presented in this study were collected using the Nutrition Questionnaire for High School Students, which was completed by 199 adolescents in a high school in southwest Florida in February of 2004. Multivariate analysis of variance (MANOVA) was used to identify differences in dietary intake and physical activity behaviors between weight status groups. The primary questions in this study related to interactions and main effects between the variables weight category, ethnicity, and gender and the dependent variables dietary intake and physical activity behaviors. Weight category was determined by computing each participant's body mass index (BMI = weight in kilograms/height in meters²). A BMI > 24.9 was considered overweight and a BMI < 25.0 was considered expected weight. Ethnicity and gender were based on self-report. The findings of this study indicate that there are group differences in dietary intake behaviors and physical activity behaviors. With respect to dietary intake behaviors, main effects were observed for weight category, gender, and ethnicity. However, follow-up univariate F-tests were not significant. The lack of statistical significances may be to due the very small sample sizes which reduced statistical power. Medium effect sizes were reported for gender differences on milk consumption (males had higher means than females), and for ethnic differences on junk food consumption (African Americans had the highest consumption followed by Caucasians and Latinos, respectively). For physical activity behaviors, main effects were observed for gender and ethnicity, but not for weight category. The follow-up univariate F-tests were significant for gender differences on vigorous activity behaviors (males had higher means than females), and for ethnic differences on moderate activity behaviors (Caucasians had the larger mean followed by African Americans and Latinos, respectively). Medium effect sizes were also observed on these pairwise comparisons. Implications for the field of school psychology are discussed with example opportunities for school psychologists to assist in the development of accommodation plans, to collaborate with medical professionals to address overweight and some of its physical and mental health consequences, to help create environments that encourage health-supporting behaviors, and to assist in the development of individual and school-wide interventions.

Research Doctorate - Doctor of Philosophy (PhD) / Maternal factors prior to conception and during pregnancy may influence the development of the metabolic, cardiovascular and endocrine systems of the offspring and subsequent disease pathogenesis. This thesis explores the concept of the developmental origins of health and disease. Human observational research studies were undertaken to test the relationships amongst maternal dietary intake, weight gain during pregnancy and changes in biochemical markers between pregnancy and postpartum for the mother and infant. This thesis presents three chapters of original research related to maternal and fetal nutrition, and one chapter of empirical data concerning the methodological challenges faced when recruiting for research purposes. An analysis of dietary intake data from the young cohort of the Australian Longitudinal Study on Women’s Health was used to determine the overall diet quality in a contemporary cohort, and to assess whether those who are pregnant eat differently to those who are not. Only small differences in diet quality and nutrient intakes were detected between pregnancy groups, and diet quality scores were consistently low. When the intake data were compared to Australian recommendations it appears that many young women fail to reach key nutrient targets, including those set for folate, fibre, calcium, iron, potassium and vitamin E. The research focus then shifted to prospective longitudinal data collection for women and their children during pregnancy and after birth. Low recruitment to this component of the studies threatened the potential to achieve the research aims. Rather than jeopardising the power of the investigations efforts were made to understand what had gone wrong and how the situation could be rectified. An investigation of the relationship between fetal adiposity and maternal weight changes in pregnancy was performed. Pre-pregnancy body mass index (BMI) and weight changes during pregnancy were taken as broad markers of maternal nutritional status and energy regulation. Intrauterine growth, including the accumulation of adipose tissue, was assessed using serial ultrasounds. Fetal size was positively related to maternal pre-pregnancy weight (and BMI) and weight gain (change in BMI) during pregnancy. Maternal pre-pregnancy weight was positively associated with adiposity at the fetal abdomen, but not the thigh. However, overall maternal weight gain was not associated with fetal adiposity. To determine whether maternal vitamin B12 and folate (methyl donors) in pregnancy could influence the offspring’s homocysteine metabolism at birth, changes in plasma vitamin B12, plasma folate and red cell folate were characterised for the cohort of more than 100 women during pregnancy and up to six months after birth. A small sub-sample of infants also had blood collected at six months postpartum. Average maternal plasma folate during pregnancy was significantly predictive of infant plasma homocysteine. In conclusion, the research outlined herein demonstrates important interactions between the mother and her offspring during the critical windows of early development. The research is multidisciplinary in its application and contributes to our understanding of some of the nutritional influences in pregnancy and postpartum for women and their children.

This thesis investigates the use of scientific evidence in the process of making public health policy. A case study located within a food regulation setting is used. The aim is to test theory against this case study. The outcome is a theoretical understanding of the use of scientific evidence in the policy-making process in a food regulation setting. Food regulation can influence food composition and food labelling and thereby affect the population's dietary intake. Frequently there are contested values, beliefs, ideologies and interests among stakeholders regarding the use of food regulation as a policy instrument to effect public health outcomes. The protection of public health and safety, taking into account evidence based practice, is generally employed by food regulators as the priority objective during the policy-making process to adjudicate among the competing expectations of stakeholders. However, this policy objective has not been clearly defined and is vulnerable to interpretation and application. The process by which folate fortification policy was made in Australia, in response to epidemiological evidence of a relationship between folate intake during the periconceptional period and reduced risk of neural tube defects, was analysed as a case study of the policy-making process. The folate fortification policy created a precedent for both food fortification and subsequently health claims policy in Australia. A social constructivist method was used to analyse the case study. The method involved deconstructing the food regulatory system into three levels; decision-making process; procedural; and political environment. Data aligned with each level of analysis was collected from 22 key informant interviews, documentary sources, field notes and surveys of both a random sample of the Australian population's knowledge of folate and use of folic acid-containing supplements (n = 5422), and the implementation of folate fortified food products into stores (n = 60). The insights that emerged from each of the three levels of analysis were assessed iteratively to identify a pattern of interrelationships associated with the policy-making process within the food regulatory system. The identified pattern was interpreted against existing theory to gain a theoretical understanding of the public health policy-making process in this political setting. The central argument of this thesis extends Sabatier and Jenkins-Smith's Advocacy Coalition Framework theory to a food regulation setting. The argument is that within the contemporary political climates of neoliberalism and globalisation, a coalition between corporate interests and the values of scientists with a positivist-reductionist approach to public health research is privileged so as to invoke certain scientific evidence to, in turn, legitimise food regulation policy decisions. The theory will help to inform policy-makers about how and why the public health policy objective in a food regulation setting is interpreted and applied. This will contribute to improving policy practice intended to effect public health outcomes. It is concluded that irrespective of the quantity and quality of the scientific evidence that is being made available, scientific evidence cannot be assumed to speak for itself Policy-making is an inherently political and value-laden process and the potential for politically motivated interpretation and application of otherwise value-neutral scientific evidence can undermine the investment in its generation. From this perspective, evidence based practice, far from liberating policy-making from political influence, can itself become part of the problem rather than the solution. Nevertheless, rational evidence based practice is an ideal to strive for and a series of recommendations is proposed to help make the use of evidence in current food regulation policy processes more transparent and democratic.

The purpose of this study was to explore the stress-eating relation established in the literature by examining a naturally occurring stressor, adolescent dating violence, and its effect on eating in adolescent girls. Specifically, analyses focused on assessing the mediating role of depression in the adolescent dating violence-fruit and vegetable intake relation and the moderating role of sports team involvement in the adolescent dating violence-depression relation. A nationally representative sample of 5,892 black, Hispanic, and white adolescent girls were surveyed using measures assessing physical and sexual dating violence experiences, depressed affect, suicidal thoughts, plans, and/or attempts, fruit and vegetable intake and involvement in team sports. This study supported the hypothesis that depression mediates the relation between adolescent dating violence and dietary intake, but only in black adolescent girls. These findings suggest that black girls victimized by dating violence experience depression, which may affect their desire or motivation to eat properly. This study also supported the hypothesis that sports team involvement, a source of social support and physical activity, moderated the relation between adolescent dating violence and depression and suicidality, but only for white adolescent girls. For this group, participating on a sports team served to protect those girls reporting dating violence from experiencing depression at the high rate reported by those dating violence victims not involved on a sports team. The findings presented in this study provide evidence that depression explains how experiences of dating violence affect eating behavior for a high-risk group, black adolescent girls. Recognizing depression’s contribution to this group’s high rate of obesity and overweight is an important step in preventing obesity and obesity-related outcomes in this population. Also, this study highlights an important source of social support, sports team involvement, and its potential to protect dating violence victims from experiencing depression and suicidal ideation, plans, and attempts.

Objective. To compare energy balance and nutrient intake of elite and non-elite school-aged gymnasts, as well as to evaluate their nutritional knowledge and eating attitude and its effect on dietary intake and practices. Methods. Demographic information, anthropometric measurements, menstrual status, sources of nutritional information, nutritional habits as well as supplement use was documented. Eating attitudes were measured by the EAT26 test and nutritional knowledge by a standardised questionnaire. Dietary intake and practices were determined with a 3-day weighed food record, while energy expenditure was measured with an Actical® accelerometer (Mini Mitter Co., Inc. Bend, OR, USA). Results. The total daily energy intake (non-elite = 6 944.37 ± 1 272.28 kJ vs. elite = 6 543.01 ± 2 570 kJ) in both groups was similar to their daily energy expenditure values (non-elite = 6 393.77 ± 1 244.19 kJ vs. elite = 6 696.09 ± 1 676.58 kJ). Elite gymnasts tended to have higher protein (21.37 vs. 15.4% total energy intake (TE), small effect size, d = 0.1) and lower fat (28.9 vs. 33.6% TE, medium effect size, d = - 0.6) intakes. More non-elite gymnasts (n = 7, 88.88%) used micronutrient supplements than elite gymnasts (n = 4, 45.45%, medium effect size, d = 0.45). Most of the gymnasts (55%) ate snacks during the day, which consisted mostly of refined carbohydrates. In the total group of gymnasts the most frequently used source of nutritional information was the coach (60%). There was no difference in nutritional knowledge between the groups (elite = 61.8% vs. non-elite = 62.8% respectively). Lastly, elite gymnasts had a practically significantly higher risk than non-elite gymnasts to follow a diet (large effect size, d = 1.32), while non-elite gymnasts exercised practically significantly more self-control over their food intake com pared to elite gymnasts (large effect size, d = - 1.03). Conclusions. South African elite gymnasts do not differ from non-elite gymnasts in terms of energy-, carbohydrate-, protein-, or fat intake. There is also no difference in energy expenditure or risk in developing an eating disorder, probably due to less competitiveness compared to other international gymnasts. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

The media has highlighted a proposed link between a gluten free diet (GFD) and weight loss. However, research related to weight gain and a GFD for persons with celiac disease (CD) has shown the opposite effect. A GFD is the only known treatment for persons with CD. If a patient with CD consumes a diet high in GF processed foods, weight management may be difficult to achieve. Participants with self-reported CD completed a modified GF food frequency questionnaire (FFQ) to assess typical dietary consumption of whole grains, sweets, fruits, vegetables and regular soda. Additionally, body mass index (BMI) and exercise were assessed. The results of this study found that whole grain, fruit and vegetable intakes were low among celiac patients. Additionally, BMI was on the high end of the normal weight range. The results of this study indicate that a greater emphasis should be placed on nutritional quality when counseling patients with CD. Registered dietitians should focus their diet counseling sessions with CD patients on a nutritious naturally GF diet in order to better manage weight.

Nutrition knowledge, dietary intake, body composition and perceived sport performance were measured before and after an eight week nutrition intervention. The sample consisted of eleven male high school football athletes aged 14-18 years old. Baseline nutrition knowledge was higher than anticipated but fruit and vegetable intake was low. As a result of the nutrition intervention, vegetable intake improved from 0.94 servings per day to 2.02 servings per day (p=0.02). Of the eleven subjects in the study, eleven conceded to both performing and feeling better as a result of the nutrition intervention. The present study suggests that a nutrition intervention can improve dietary intake and perceived sport performance among adolescent athletes.

The aim of the present study was to investigate all long-term institutions in the county of Västerbotten, Northern Sweden, to give a detailed description of the institutionalized population with respect to motor functions, vision, hearing, speech, ADL-functions, prevalence of psychiatric symptoms and behavioral disturbances, staff work load, use of psychoactive drugs and prevalence of dementia. Another aim was to select some specific 'problem areas' in the nursing care of demented patients for further descriptive and interventional studies. For this reason, morning care procedure (hygiene, dressing), meal behavior (eating, communication), nutrition, constipation and relocation between institutions were selected. The results of the study have been reported in six papers summarized below: I.The study has shown that the proportion of demented patients is increasing in longterm institutions in Sweden. Furthermore, demented patients were shown to be more impaired in all rated functioning abilities and exhibited more psychiatric symptoms and behavioral symptoms. A high proportion of the demented probands were also prescribed psychoactive drugs, i.e. neuroleptics. II. Five patients with Alzheimer-type dementia were monitored during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients were able to manage morning care independently, but there was a wide variation in their highest level of performance. III. Five patients with Alzheimer-type dementia were observed (video taped) during their meals in a changed meal milieu and with new meal routines. When the patients ate without staff participation, the two least demented patients became 'caregivers'. When two mental nurses joined the group, first in civil clothes and then in white uniforms, the patients dropped their roles as helpers. The patients were able to compose complete meals in 0-79 per cent of the meals. The conversation during the meals could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all utterances were about food and eating and almost all conversation concerned the present time. IV. Thirty-three psychogeriatric patients, with severe constipation were given a high- bran bread instead of their accustomed laxatives. During the high-bran treatment period, the number of bowel evacuations and the volume of faeces increased. The total laxative consumption decreased by 93 per cent. V. Nutritional status and dietary intake were studied in a sample of severely demented, institutionalized patients. Energy and /or protein malnutrition was found in 50 per cent of the patients. The mean energy intake was 2059 kcal. Malnourished patients had had four times as many infectious periods during their hospital stay as patients without malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay. VI. Thirty-three psychogeriatric patients were followed for 36 weeks after relocation from a mental hospital to two newly built nursing homes. An intensive pre-relocation program was performed. No negative effects of the relocation were found. On the contrary, the relocated group improved their ADL-functions after the transfer. Based upon the above cited studies, a model for nursing care of demented patients is presented. / <p>S. 1-45: sammanfattning, s. 46-192: 6 uppsatser</p> / digitalisering@umu

Type 2 diabetes and cardiovascular disease (CVD), major public health concerns in Canada and worldwide, are the main outcomes of Metabolic Syndrome (MetS). MetS is a clustering of five chronic disease risk factors, including abdominal obesity, dyslipidemia (elevated triglycerides and reduced high-density lipoprotein cholesterol level), hypertension, and elevated fasting plasma glucose. Abdominal obesity and insulin resistance are the main factors contributing to development of MetS and thus CVD and diabetes. Further, dyslipidemia (specifically the total cholesterol/HDL-C ratio) is necessary to be monitored in people with these diseases or risk factors. The Canadian Health Measures Survey (CHMS) has direct health measurements that provide the opportunity to identify risk factors associated with chronic disease. Further, dietary intake has been assessed in CHMS, which can be utilized to evaluate the association with diseases and risk factors controlling for potential covariates. To examine the association between dietary intake with MetS and associated risks and diseases in Canadian adults and adolescents, data from CHMS cycle1, 2007-2009 (n=5604, aged 6-79 y) were used in which dietary intake was assessed using a semi-quantitative food frequency questionnaire. Frequency of food intake (times/day) and the distribution of individuals with and without disease or risk factors by socio-demographic characteristic was determined. Further, the association between dietary intake and each disease or risk factor was evaluated using logistic models. Data manipulation, cleaning, and creation of new variables were done using IBM SPSS statistics for windows, version 20. All statistical analyses were conducted by STATA/SE 11, StataCorp. As per Statistics Canada’s recommendation, data were weighted and bootstrapped using specific commands in STATA in order to be representative of the Canadian population. Physically active Canadians had significantly more milk and dairy product, fresh fruit and vegetable, and fruit and vegetable juice intake compared to inactive Canadians. Low-income households had significantly greater intakes of sugar-sweetened beverages (SSBs) and lower amounts of fresh fruit and vegetables than high-income households. Individuals with the lowest level of education had greatest potato and lowest fruit and vegetable juice intake. The prevalence of abdominal obesity (12-79 y), elevated TC/HDL-C ratio (20-79 y), MetS (12-79 y), and diabetes (20-79 y) was 35.7%, 20.5%, 18.3%, and 7.5%, respectively. The overall estimated percent risk of CVD over 10 years in adults aged 30-74 y was 8.66%. Abdominal obesity had the greatest contribution (~90%) to development of MetS in each age group compared to other components of MetS. Also, abdominal obesity was a strong significant predictor for development of other risk factors and chronic diseases including elevated TC/HDL-C ratio, diabetes, and CVD (OR: 6.12, CI: 2.68-13.96; OR: 2.25, CI: 1.24-4.06, OR: 1.4, CI: 1.06-1.87, respectively). High consumption of diet soft drink was associated with increased risk of abdominal obesity, Mets, diabetes, and elevated TC/HDL-C ratio. High consumption of fruit and vegetables and cereal was associated with decreased risk of CVD over 10 years whereas potato intake increased the risk. Intake of nuts appeared to be associated with reduction in the risk of MetS among Canadians. Dietary fat intake of one to less than 5 times/week was associated with increased risk of abdominal obesity in individuals over 40 years of age compared to 12-19 y individuals. Further, “ever drinking” alcohol compared to “never drinking” alcohol was associated with decreased risk of diabetes and elevated TC/HDL-C ratio. Low level of education contributed to development of abdominal obesity. Thus, abdominally obese individuals with specifically elevated TC/HDL-C ratio are at risk of developing MetS, CVD, and diabetes. They need to be educated with specific focus on physical activity, and greater intake of fruit and vegetables, nuts, and lower intake of dietary fat, diet soft drinks, and potato. Additionally, considering the social determinants which might contribute to increase the risk of chronic diseases or risk factors such as income, housing, accessibility to facilities in neighborhoods, school programs, or community programs is essential.