Balanced Meal Research Articles

Values for Digestible Indispensable Amino Acid Score (DIAAS) Determined in Pigs Are Greater for Milk Than for Breakfast Cereals, but DIAAS Values for Individual Ingredients Are Additive in Combined Meals

BackgroundBreakfast cereals contain low-quality proteins and are often consumed with milk. The digestible indispensable amino acid score (DIAAS) has been used to evaluate protein quality, but it is not known if DIAAS obtained in individual foods is additive in combined meals. ObjectivesThe following hypotheses were tested: amino acids (AAs) in milk complement AAs in breakfast cereals to provide a balanced meal, and DIAAS in individual foods is additive in combined meals. MethodsSix ileal cannulated gilts [body weight mean: 55.6 ± 3.7 (SD) kg] were allotted to a 6 × 6 Latin square with six 7-d periods. Ileal digesta were collected for 9 h on days 6 and 7 of each period. Three diets contained a breakfast cereal (i.e., cornflakes or quick oats) or dry milk as the sole source of AAs. Two additional diets contained a combination of dry milk and cornflakes or quick oats. A nitrogen-free diet was also used, and DIAAS was calculated for cornflakes, quick oats, dry milk, and the 2 combined meals for children aged 6 to 36 mo and individuals older than 36 mo through adulthood. For the combined meals, DIAAS was also predicted from the individual ingredient DIAAS. ResultsDry milk had greater (P < 0.05) DIAAS (123 and 144) than quick oats (57 and 67), but cornflakes had less (P < 0.05) DIAAS (16 and 19) than the other ingredients. Both breakfast cereal–dry milk meals had DIAAS close to or greater than 100 for children aged 6 mo to 3 y and for older children, adolescents, and adults, but there were no differences between measured and predicted DIAAS. ConclusionsThe combination of milk and breakfast cereals results in a meal that is balanced in indispensable AAs for humans, and DIAAS obtained from individual ingredients is additive in mixed meals.

Nutrition counseling and monitoring via tele-nutrition for healthy diet for people with spinal cord injury: A case series analyses

Objective To evaluate the effect of a tele-nutrition counseling program on diet quality, weight, waist circumference, and quality of life in people with spinal cord injury (SCI). Design Prospective observational study. Participants Fifteen participants with SCI were enrolled from an acute inpatient rehabilitation unit and outpatient SCI clinic; ten participants completed the intervention. Interventions Six tele-nutrition counseling sessions over 3 months, utilizing videoconferencing and a photographic food diary. Outcome measures Weight, waist circumference, Life Satisfaction Index A (LSIA), Knowledge and Nutrition Evaluation with Supplement on Eating Behavior, and Program Satisfaction Survey (PSS). Results Ten participants completed both baseline and 3-month follow-up evaluations and were used in this analysis. There were no statistically significant changes from baseline to 3-month follow up in weight, waist circumference, Knowledge and Nutrition Evaluation, and LSIA (P > .48). Using the Supplement on Eating Behavior total score to measure overall changes in healthy food choices, 9 out of 10 participants rated their healthy food choices as improving (P = .008). A post-hoc exploratory itemized analysis on the Supplement on Eating Behavior revealed significant improvements from baseline to 3-month follow-up in participant’s self-reported choice of balanced meals (P = .008), reading food labels (P = .031), logging meals (P = .007), and monitoring portions of eating favorite foods (P = .031). Participants endorsed a 97-100% satisfaction rating in relation to perceived health benefits, equipment, and program satisfaction. Conclusion This study provides preliminary data suggesting that tele-nutrition is an efficacious intervention that may improve diet quality for individuals with SCI.

Developing a methodology to create nutritionally balanced meals

PurposeThe purpose of the present study was to develop a methodology for the creation of nutritionally balanced (NB) recipes and meals.Design/methodology/approachNutritional criteria were set for energy, fats, saturated fats, carbohydrates, sugars and salt. A sample of 50 main courses and 29 salads was evaluated and nutritionally reformulated to meet the criteria. One sample t-test, paired sample t-test, Pearson correlation coefficient and linear regression analysis were performed.FindingsThe original main courses and salads did not meet the nutritional criteria for fats and energy. Both original and NB main courses had high mean protein content. The reformulation of recipes caused a significant change on the provided energy (−50.2%), fats (−57.6%), saturated fats (−58.8%), carbohydrates (−24.2%), proteins (−35.6%) and salt (−53.8%) for the salads (p = 0.001). Accordingly, reformulation of recipes caused a significant change on provided energy (−38.4%), fats (−55.2%), saturated fats (−58.3%), proteins (−25.9%) and salt (−50%) for the main courses (p < 0.001). Predictive models (linear regression analysis) for fats (R2 = 0.345), proteins (R2 = 0.876) and carbohydrates (R2 = 0.797) on the NB recipes were performed.Originality/valueThis is the first attempt to improve the nutritional value of cooking recipes, based on specific nutritional criteria. A methodological procedure for the creation of NB meals is proposed. This methodology could be a useful tool for the nutritionists and chefs, which, in a context of cooperation, could create databases and cooking books with NB recipes easily accessed to public and caterers. The recipes that constitute NB meals could guarantee the standardization of the recipes' reformulation, within a certification standard for restaurants.

Meal patterns and incident hypertension in community-dwelling middle-aged adults: an 11-year follow-up cohort study.

We aimed to examine whether meal patterns, as well as energy intake from three main meals and snacks, were associated with incident hypertension. We included 12 995 participants aged 18-59 years from the China Health and Nutrition Survey in the final analysis. Dietary intake was assessed using weighing methods in combination with 24-h food records. Cox proportional hazards regression models were used to examine the association of meal patterns, and energy intake from different meals with incident hypertension. During a mean follow-up of 11.2 years, 4766 new hypertension cases were documented. Four meal patterns were derived according to energy intake: balanced, breakfast dominant, lunch dominant, and dinner dominant patterns. Dinner dominant meal pattern was associated with a lower risk of incident hypertension [hazard ratio (95% confidence interval): 0.90 (0.84-0.98)] compared with the balanced meal pattern. Breakfast energy intake was positively, but dinner energy intake was inversely associated with incident hypertension. The positive association between breakfast energy intake and incident hypertension was observed in rural residents only [1.22 (1.07-1.41) for rural residents, 0.98 (0.82-1.18) for urban residents; P interaction = 0.0348]. A positive association between energy intake from lunch and incident hypertension was observed in the urban residents only. Dinner dominant meal pattern was associated with a lower risk of hypertension compared with the balanced meal pattern in Chinese adults. A relatively small breakfast and large dinner may help to prevent or delay the development of hypertension, especially in urban residents.

Urban Fijian Indigenous Families’ Positive and Negative Diet, Eating and Food Purchasing Experiences During the COVID 19 Safety Protocols

The Greater Suva Urban Area (GSUA) is the most densely populated area in Fiji and was greatly affected by the second wave of the COVID-19 outbreak. This study explores how lockdown and other COVID-19 safety protocols impacted the diets, eating behaviour and food purchasing behaviour of iTaukei (indigenous Fijian) families living in the GSUA. In-depth interviews with 13 iTaukei mothers from diverse socio-economic and occupational backgrounds highlight that loss of income was related to food insecurity, which also affected access to balanced meals and dietary diversity. Women also noted positive changes, including (1) reduced consumption of red and processed meat, (2) increased consumption of fruits and vegetables, (3) reduction in eating out and greater reliance on home-cooked meals, (4) reduction in food wastage, (5) increase in home gardening, and (6) greater concern for health and well-being. Unhealthy eating behaviours were also recorded, including greater reliance on energy-dense foods, increased cooking and baking of unhealthy foods, increased snacking, and replacing dinner with tea, snacks and sugary foods. These findings raise concerns about the long-term effects of COVID19 safety protocols on health and well-being and provide insights into opportunities for promoting healthier eating lifestyles, better management of resources, and enhancing food security.

Development and validation of a meal quality index with applications to NHANES 2005-2014.

The Meal Balance Index (MBI) assesses the nutritional quality and balance of meals. It is a score between 0 and 100 that takes into account both shortfall and excess nutrients, adjusted for the energy content of the meal. In the present study the score was applied to 147849 meals reported in the National Health and Nutrition Examination Surveys (NHANES) 2005-2014 in order to evaluate its validity and compare against exemplary meals designed as part of 24h diets that meet US dietary guidelines. Meals from exemplary menu plans developed by nutrition experts scored on average 76±14 (mean ± standard deviation) whereas those of NHANES participants scored 45±14. Scores of breakfast, lunch, dinner, snack, considered jointly as independent variables, were moderately but positively and significantly associated with the Healthy Eating Index (Pearson correlation 0.6). MBI scores were significantly associated with the density of positive micronutrients (e.g. Vit A, Vit C) and favorable food groups (e.g. fruits, whole grains) not directly included in the MBI algorithm. The MBI is a valid tool to assess the nutritional quality of meals reported in the US population and if applied to culinary recipe websites could potentially help users to understand which meals are nutritionally balanced. Choice of more balanced individual meals can guide healthier cooking and eating.

Should we increase the focus on diet when considering associations between lifestyle habits and deliberate self-harm?

BackgroundDespite increasing awareness of high rates of physical illness and poor lifestyle behaviours among patients with a history of repeated deliberate self-harm (DSH), there is little research on specific lifestyle factors that are potentially problematic for this group. This paper aims to explore the relationship between lifetime repeated DSH and certain lifestyle factors, including balanced meals, eating breakfast, consumption of ‘junk’ food, weight, exercise, substance/alcohol use, smoking and social support, in a cohort of patients who presented to the Emergency Department (ED) with suicidal ideation or DSH.MethodsFrom 2007 to 2016, data from lifestyle and mental health measures were collected from 448 attenders at an outpatient clinic for DSH or suicidal ideation following ED presentation. Lifestyle behaviours (Fantastic Lifestyle Checklist) and mental health (Depression and Anxiety Stress Scale), clinical diagnosis and number of previous DSH episodes were measured on arrival. The associations between lifestyle variables and the number of lifetime DSH episodes were examined.ResultsSex, age, depression symptoms, poor diet, and smoking were all associated with a higher average number of deliberate self-harm episodes across the lifespan. There were non-significant positive trends for the other poor lifestyle behaviours. There was no association between DSH episodes and diagnosis of depression or anxiety disorder. In a multiple linear regression model, the only factors that remained significant were age, smoking and eating balanced meals, however, the relationship between smoking and lifetime DSH was moderated by more immediate DSH behaviours.ConclusionIn this sample of patients referred to a service following presentation to the ED with acute mental health concerns, balanced meals and smoking were the lifestyle behaviours that were found to have the strongest independent association with repeated DSH across the lifespan.

Evaluation of Dietary Life Instruction in Middle School Home Economics by Converging Habermas’s Three Systems of Action

This study developed and implemented a teaching · learning process plan for Home Economics in middle school by converging Habermas’s three systems of action. It also examined the effect of the class through the evaluation of students and teachers who participated in the class. This study developed 10 sessions for a teaching and learning process plan by converging three systems of action and reconstructing learning elements related to ‘balanced meal plan’ and ‘food choice’ according to the practical action teaching model. After class, we surveyed the degree of help for students, analyzed the learning activity sheets, and analyzed the reflection journals of teachers to evaluate the effects of the class.&lt;br/&gt;This class was found to be the most helpful in practicing the healthy dietary life of students, expanding their thoughts, understanding learning contents, and helping them change their lives. As a result of analyzing the learning activity sheet, students gained enlightenment by reflecting and evaluating their action through the class; in addition, changes in interest, awareness, and action appeared. Through the convergence of three systems of action, teachers who practiced the class criticized and realized the act that students were unconsciously accepted. In addition, it confirmed the possibility that students could change their lives, family and society by promoting optimal nutrition and health for a good life that pursues the best good.

Medycyna stylu życia jako prozdrowotny trend współczesnego prosumenta

The aim of this study is to present the profile of the modern prosumer and analyze their behavior on the health services market in the context of the latest health-promoting trend — lifestyle medicine. The patient’s participation in medical diagnostics was discussed. Attention was paid to the reasons for transformation of medical systems, among others due to changes in the patient’s needs. The theoretical aspects of lifestyle medicine, including evidence-based medicine (EBM), were discussed. Finally, an analysis of the lifestyle of Polish consumers was made based on the results of own study. Less than 20% of respondents are familiar with the term “lifestyle medicine”. Most respondents identify this term with a healthy lifestyle. The respondents’ declarations show that the modern consumer leads a healthy lifestyle, regularly engaging in sports and eating properly balanced meals. As an informed consumer, he or she reads the labels on the packaging and considers each purchase very carefully. He or she is also vulnerable to advertising and other marketing tools, and is aware of this. Nearly 61% of respondents do not know the term “prosumer”. For other people, a prosumer is the modern consumer who consciously and actively makes choices, is involved in co-creating the product and takes part in its promotion.

Food Insecurity Among Single Parents and Seniors: a Case Study in an Urban Population in Canada

Single parents and seniors are believed to encounter more food insecurity due to a complex web of disadvantages and discrimination. We carried out a community-based cross-sectional survey of single parents and seniors in an urban population to explore the level of nutritional awareness, household meal practices, challenges, and their coping strategies. The survey questionnaire was adapted from the Canadian Community Health Survey. Fifty single parents and forty-eight seniors were interviewed in the city of St. John’s, Canada. Findings indicate that single parents were more disadvantaged than seniors and more vulnerable to food insecurity. For seniors, in addition to poverty, existing physical disabilities and loneliness limit the use of public transportation to grocery stores and affect their ability/motivation to prepare balanced home-made meals. The jobs of single parents result in time constraints, which limit the attention they can give to the quality of their children’s diets and to accessing information about cheap yet healthy diet alternatives. We conclude by strongly advocating for improving the social safety net, particularly for single parents, for instance by promoting financial security, skill development, flexible working hours, and affordable childcare. Seniors need interaction with peers to encourage the eating of balanced meals, along with the increased promotion of healthy foods.

Frequency of consumption of balanced meals, bodyweight gain and incident risk of glucose intolerance in Japanese men and women: A cohort study.

Aims/IntroductionThis cohort study assessed the risk for bodyweight gain and development of glucose intolerance based on the frequency of consumption of balanced meals including grain, fish or meat and vegetables.Materials and MethodsThe participants (8,573 men, 3,327 women) were employees of a company in Japan. A self‐administered questionnaire was used to evaluate the frequency of balanced meal consumption. Bodyweight changes and the incidence of glucose intolerance (glycated hemoglobin >6.0%) during the 3‐year follow‐up period were determined through annual health examinations.ResultsThe mean bodyweight change over a period of 3 years was 0.78 kg for men and 0.84 kg for women. A lower frequency of balanced meals was associated with a higher bodyweight gain for men (P for trend = 0.004), but not for women. During the study, 464 men and 115 women developed glucose intolerance. Overall, the frequency of balanced meals was not associated with the risk of glucose intolerance in either sex. However, the interaction between the frequency of balanced meals and degree of obesity had a significant effect on the incidence of glucose intolerance in men (P = 0.005), with less frequent consumption of balanced meals being associated with a higher risk for glucose intolerance among men with a BMI ≥25.0 kg/m2 (P for trend = 0.007).ConclusionsA higher frequency of balanced meals, including grain, fish or meat and vegetable dishes – important components of healthy Japanese food – was associated with a lower risk of glucose intolerance in obese men, but not in non‐obese men and women.

Unmet social needs among low-income adults in the United States: Associations with health care access and quality.

ObjectiveTo describe social needs among low‐income adults and estimate the relationship between level of unmet social needs and key indicators of health care access and quality.Data SourceNational survey data from 12 states from the 2017 Behavioral Risk Factor Surveillance System, which added a “Social Determinants of Health” Module in 2017.Study DesignWe examined differences in eight measures of health care access and quality (eg, check‐up in last 12 months, inability to see doctor due to cost, receipt of eye examination for diabetics) for low‐income adults with 0, 1, 2‐3, and 4+ unmet social needs based on 7 social needs measures. We used adjusted logistic regression models to estimate the association between level of unmet need and each outcome.Principal FindingsMost common unmet social needs included not having enough money for balanced meals (33 percent) or food (32 percent). After adjusting for observable characteristics, higher levels of unmet social need were associated with poorer access and quality. Compared to those with no reported unmet needs, having 4+ unmet needs was significantly associated with reduced probability of having a yearly check‐up (65 percent vs 78 percent, adjusted difference = −7.1 percentage points (PP)), receiving a flu vaccine (33 percent vs 42 percent, adjusted difference = −5.4 PP), having a personal doctor (74 percent vs 80 percent, adjusted difference = −3.1 PP), and having a foot (63 percent vs 80 percent, adjusted difference = −12.8 PP) or eye examination (61 percent vs 73 percent, adjusted difference = −12.6 PP) for diabetic patients, and increased probability of being unable to see a doctor due to cost (44 percent vs 9 percent, adjusted difference = 27.9 PP) and having diabetes affect the eyes (22 percent vs 19 percent, adjusted difference = 8.0 PP) at α = 0.05.ConclusionsHigher levels of unmet social needs were associated with poorer access to and quality of care among low‐income adults. Addressing social needs both inside and outside of health care settings may help mitigate these negative effects. Additional research on if and how to effectively do so is critical.

A halve salt reduction intervention doesn’t affect the acceptance of school lunch

Abstract Background Considering the high salt consumption by children and their impact on future health, is utmost importance the salt reduction on school meals. Though, it is essential to evaluate the acceptance of less salty meals to guarantee that nutritional requirements are not compromised. Methods This case study was performed at a Portuguese primary school, in city of Porto, including all children aged between 3 and 10 years. Added salt per meal was determined for dishes and soups, during 5 consecutive days in 1st and 2nd phases, by weighing salt added during meals preparation and considering the average portion served to children. An intervention for salt reduction was performed by halve the added salt through cooks training. Meals acceptance was evaluated by plate waste determination, using the aggregated weighing method, in order to compare differences in acceptance of school lunch before and after salt reduction. Results A total of 475 meals was evaluated. Before intervention, it was observed a mean value for added salt of 0.786g (±0.073g) for soup and 1.156g (±0.411g) for dish, totalized 1.942g (±0.393g) of salt added per meal, value higher than recommended for lunch (about 1.5g). During intervention, it was experienced a reduction of added salt between 45.7% and 52.8% for soup and between 41.3% and 50.6% for dish. The salt mean value added per meal was 1.010g (±0.170g), allowed the achievement of recommendations. There were no differences neither in the dish plate waste (p = 0.094) nor in the soup waste (p = 0.838) between the two phases. Conclusions This study showed that a 50% reduction of added salt doesn't affect the acceptance of school lunch by children aged between 3 and 10 years old. The success of this intervention could be important for developing school food policies in order to offer balanced meals either with an adequate salt content to achieve World Health Organization goals for salt reduction and consequently enhance public health. Key messages It has been possible to halve added salt on school lunch without affect children’s consumption. School policies aiming to promote healthy eating habits by reducing meals salt availability could be effective.

The Pappa di Parma project: promoting better health and social condition in developing countries

Abstract Background Malnutrition is the primary cause of death in infants and children. Malnutrition is very common in individuals aged from 6 to 60 months due to the lack of high-quality protein and to deficiencies in the intake of vitamin A, D, thiamine, riboflavin, niacin, calcium and iron. In low-income countries, the nutritional approach to treat child malnutrition is mainly based on RUTFs (Ready-to-Use Therapeutic Foods). Being produced by donor countries, RUTFs do not solve the problem of malnutrition at source: RUTFs are expensive for low-income communities and are distant from their local tradition. The use of ingredients not locally available and the passive participation of the community are the main cause of RUTFs failure among mothers of malnourished children. Community engagement and educating the local populations represent a key element in addressing the causes and treatment of malnutrition. Results Based on these concepts, the Pappa di Parma project, developed at Department of Food and Drug of University of Parma, aims to create a hyper-energetic and nutritional balanced meal, tailored on children from 6 to 60 months suffering from severe/moderate malnutrition, including only affordable local ingredients and technologies, providing in this way a potential long-term solution to decrease malnutrition. Conclusions The Pappa di Parma approach has been applied in Sierra Leone, Zambia, Tanzania, Burundi, Senegal, Togo from 2009 adapting to the different context. The Pappa di Parma approach consists in: (a) identifying the local food and creating a nutritional database; (b) developing recipes with accessible-to-family ingredients and with local technologies; (c) testing in loco the recipes in the real setting; (d) creating educational materials aiming to enhance awareness about the importance of a balanced nutrition.

Examining social determinants by locale to inform community linkages

Abstract Achieving a long-lasting impact on health outcomes requires focus not just on patient care, but also on community approaches aimed at improving population health through addressing gaps in Social Determinants of Health (SDOH). SDOH have been found to disproportionately affect those in low-income brackets and the disabled to varying degrees based on locale. The purpose of this exploratory research was to determine 1) which SDOH have the greatest negative impact on disabled and elderly populations within four targeted states (Iowa, Ohio, Minnesota, Wisconsin) and 2) if there is a difference in negative SDOH impact between metro and non-metro locales. Individual-level data were obtained from disabled persons aged 65 years or older who responded to the Centers for Disease Control and Prevention's 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey. Utilizing these data, frequency distributions were obtained using SPSS. Rank order variation in SDOH was observed among four Midwestern states and between metro vs. non-metro geographic regions. Frequency distributions assisted in identifying the greatest negative impacting SDOH on elderly disabled populations. An examination of the rank order tables allowed the investigator to accurately assess the rank of negative impacts. There were variabilities in responses to questions with moving two or more times within 12 months having the lowest negative impact. When regrouped based upon SDOH negative impacts, were you able to pay your bills was the most frequent SDOH across all states. Feeling unsafe or extremely unsafe in your neighborhood was the highest negatively impacted SDOH within states. Cited determinants in three categories were highest in Ohio. Ohio also had the highest proportion of negatively impacted SDOH across all states. No money for balanced meals was a close second SDOH across states. Key messages Social Determinants Impacting Elderly Disabled. Impact of Social Determinants by Geography.

How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the "Balanced Plate" Intervention.

Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observations of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Future implementation of the intervention should tailor the strategies to the local context to ensure optimal adherence to the intervention.

Younger cancer survivors are more likely to face financial strain.

Paying for daily living necessities such as food, housing, and other monthly bills puts a more significant strain on younger cancer survivors, even years after their diagnosis, according to findings published in the March 2020 issue of the Journal of the National Comprehensive Cancer Network.1 Among survivors of cancer who are aged 18 to 39 years, the study found that approximately 20.4% expressed high levels of worry about paying their monthly bills compared with 12.9% of individuals who did not have a history of cancer. Furthermore, approximately 6.3% of survivors in that same age group noted that they were unable to afford balanced meals compared with 3.4% of respondents without a cancer history. Older survivors aged 40 to 64 years reported less consistent findings, and the disparities were not noted to be present among participants aged 65 years and older. According to the study's lead researcher Zhiyuan “Jason” Zheng, PhD, a health economist and principal scientist in the Surveillance and Health Services Research program at the American Cancer Society, in Atlanta, Georgia, one possible reason for the disparity could be that younger cancer survivors' health conditions may cause them to lose their jobs and health insurance coverage. Child-rearing demands, mortgage obligations, student loans, low rates of savings, and significantly increasing costs of cancer care likely compound the problem further, he adds. Dr. Zheng and his colleagues used the 2013 to 2017 National Health Interview Survey, a cross-sectional household survey from the Centers for Disease Control and Prevention. It included more than 12,000 cancer survivors, excluding survivors of nonmelanoma skin cancer, who were aged 18 to 65 years and older. Financial concerns were sorted into categories related to retirement, the standard of living, monthly bills, and housing costs. The investigators assigned a point system based on concerns ranging from “very worried” to “not worried at all.” The analysis found that approximately 26.4% of cancer survivors aged 18 to 39 years reported severe financial worry, whereas 12.6% reported severe food insecurity. The results among survivors aged 40 to 64 years demonstrated approximately 22.2% reporting severe financial worry compared with 6.8% reporting severe food insecurity. In the survivor cohort aged 65 years and older, approximately 6.9% reported severe financial worry whereas 2.3% reported severe food insecurity. Dr. Zheng emphasizes the importance of addressing the needs of younger, low-income cancer survivors with higher numbers of comorbid conditions through clinical and health policy interventions that help to minimize their financial burdens and food insecurity. He points to promising developments, such as The Deferment for Active Cancer Treatment Act, passed by Congress in 2018, which allows patients with cancer to postpone payments on public student loans while they are actively receiving cancer treatment. At the same time, the Centers for Medicare and Medicaid Services has expanded coverage for young people with disabilities to include healthy groceries, rides to medical appointments, and home-delivered meals. The authors call for future research evaluating the impact of various financial hardships on outcomes among long-term cancer survivors.

P81 Development and Reliability Testing of a Nutrition Knowledge Questionnaire for Australian Children (CNK-AU)

<h3>Background</h3> Increased nutrition knowledge is related to better eating behavior. However, internationally, there are few reliable and validated tools to measure the nutrition knowledge of children, and a tool aimed at Australian children is lacking entirely. <h3>Objective</h3> Developing a valid and reliable tool that can be used by practitioners and researchers to assess children's level of nutrition knowledge. <h3>Study Design, Setting, Participants</h3> A team of nutrition and education experts developed a nutrition knowledge survey for Australian children aged 8-12 years, based on an existing and validated Belgian survey. The questions were translated and adapted to confirm with Australian culture and governmental recommendations. It consists of 8 nutrition-related categories: ‘healthy choices', ‘portion and serve sizes', ‘balanced meals', ‘nutrition labels', ‘nutrient functions' and food- ‘sources', ‘safety' and ‘categories'. Year 5 and 6 students (n = 94, age = 10.9, SD = 0.76) at a primary school in Newcastle, Australia were recruited and completed the nutrition knowledge survey twice, with one week in between. The questionnaire was filled out online, using an Android tablet. Teachers were asked not to teach any nutrition between the measurements. <h3>Measurable Outcome/Analysis</h3> Item analysis showed varied item difficulty and discrimination. The interrater reliability per item between T0 and T1, was moderate to substantial for the majority of the items (mean κ = 0.50, SD = 0.21). Test retests showed a significant correlation for the total score (r = .756) and all categories except ‘Portion and serve sizes' (‘healthy choices' [r = .616], ‘balanced meals' [r = .585], ‘nutrition labels' [r = .595], ‘nutrient functions' [r = .582] and food- ‘sources' [r = .455], ‘safety' [r = .502] and ‘categories' [r = .825]). <h3>Conclusions</h3> The CNK-AU was found to be a practical and reliable tool for measuring Australian children's nutrition knowledge. The tool may be useful in future work to determine the effectiveness of educational interventions and can be adapted to other cultures.

Formative Research to Inform the Development of a Healthy Eating Social Marketing Campaign in Mississippi

Mississippi leads the nation in child obesity, chronic diseases, poverty, and food insecurity. Stemming the long-term consequences of high obesity rates will require a cultural attitude and behavioral shift towards healthy eating. This study explored the perceptions, beliefs, practices, and self-efficacy towards healthy eating among limited resource Mississippi parents to inform a SNAP-Ed social marketing campaign. A statewide telephone survey was conducted with income-eligible or current SNAP recipients who provided or prepared food for children in their household. Likert-type scale questions measured intrapersonal factors, self-efficacy, and practices regarding healthy eating, such as shopping and meal planning. A total of 206 surveys were analyzed. Seventy-nine percent (n=163) of participants were currently receiving SNAP benefits. Healthy eating was perceived as balanced meals and fruits and vegetables. Though 60% agreed that cost was a barrier to eating more fruits and vegetables, 90% of participants had positive attitudes and beliefs towards healthy eating. In summary, Mississippi parents with limited resources were interested in providing healthy balanced meals but faced cost as the major barrier. A social marketing message with this population can be effective in emphasizing affordable healthy meals.

Five Evidence-Based Lifestyle Habits People With Diabetes Can Use.

Several evidence-based lifestyle habits focusing on the composition, timing, and sequence of meals and on pre- and postmeal exercise can improve diabetes management. Consuming low-carbohydrate, balanced meals and eating most carbohydrates early in the day are helpful habits. Eating the protein and vegetable components of a meal first and consuming the carbohydrates 30 minutes later can moderate glucose levels. Postmeal glucose surges can be blunted without precipitating hypoglycemia with moderate exercise 30-60 minutes before the anticipated peak. Short-duration, high-intensity exercise could also be effective. Premeal exercise can improve insulin sensitivity but can also cause post-exertion glucose elevations. Moreover, high-intensity premeal exercise may precipitate delayed hypoglycemia in some people. Glycemia benefits can be enhanced by eating a light, balanced breakfast after premeal exercise.