Dietary Behavior Change Research Articles

Factors associated with dietary behaviour change support in patients: A qualitative study among community nurses.

To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes. Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long-term complications from chronic lifestyle-related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential. A qualitative descriptive study. Data were collected in the Netherlands in 2018-2019 via semi-structured face-to-face interviews with 18 nurses. Interview guide themes were informed by the COM-B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis. Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse-patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context. It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet. The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self-management. Well-fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients. A nurse provided feedback on the interview guide.

A Qualitative Evaluation of a Plate-Method Dietary Self-Monitoring Tool in a Sample of Adults Over 50

BackgroundSelf-monitoring is an important behavioral change technique to help users initiate and maintain dietary changes. Diet self-monitoring tools often involve the itemization of foods and recording of serving sizes. However, this traditional method of tracking does not conform to food guides using plate-based approach to nutrition education, such as the 2019 Canada’s Food Guide (CFG). ObjectiveTo explore the acceptability, facilitators and barriers of using a plate-based dietary self-monitoring tool based on the 2019 CFG (Plate Tool) compared with a traditional Food Journal (Food Journal). MethodsThe 2 dietary self-monitoring tools were compared using a crossover study design over 2 wk. Adults over 50 (n = 47) from Montreal, Canada, were randomly assigned to use one tool over 3 d during 1 wk, then used the other tool the next week. Semistructured interviews (n = 45) were conducted after completing the second tool. A qualitative description of the interviews was conducted through an inductive determination of themes. ResultsFacilitators to using the Plate Tool were its simplicity, quick completion time compared with the Food Journal and easiness to use, increased awareness of dietary habits and accountability, with participants expressing that it could help users make informed dietary changes aligning with the CFG. However, barriers to using the Plate Tool were its lack of precision, the participants’ difficulty categorizing foods into the CFG categories and recording intake of foods not present on the CFG. ConclusionsThe Plate Tool is an acceptable dietary self-monitoring tool for healthy adults over 50. Self-monitoring tools based on the plate method should take the barriers described in this study into account. Future studies should compare dietary self-monitoring methods to assess adherence and effectiveness at eliciting dietary behavior change.

Iron deficiency anaemia and effect of nutrition education on change in dietary behavior among the adolescent girls of tea garden area in Nagaon district, Assam

Iron deficiency anaemia and effect of nutrition education on change in dietary behavior among the adolescent girls of tea garden area in Nagaon district, Assam

P11-005-23 The Importance of Vitamin and Mineral Tracking as Part of the Nutrition Education and Dietary Behavior Changes

P11-005-23 The Importance of Vitamin and Mineral Tracking as Part of the Nutrition Education and Dietary Behavior Changes

Changes in dietary habit and physical activity among the diabetic patients of Bangladesh during COVID-19: A cross-sectional study.

In an effort to avert further Covid-19 transmission, the Bangladesh government took several initiatives which disrupted the routine food intake and exercise of diabetic patients. This study sought to examine the difference in dietary and exercise habits of diabetic patients between their pre-pandemic status and during COVID-19 which may be attributed to the observed poor health outcomes during the study period. This was a cross-sectional study that enrolled 604 diabetic patients using a convenience sampling technique who were attending outpatient clinics of the three selected hospitals in Bangladesh. A validated semi-structured questionnaire was used to collect information regarding eating habit and physical activity of the respondents pre- and during COVID-19 pandemic via direct interview. McNemar-Bowker test was used to assess the changes in dietary and physical activity behaviors. The current study reveals that 93.9% of the respondents were type-2 diabetic patients. During the pandemic, there was a decrease in the consumption of rice, bread, meat, fish, eggs, and dessert, while the consumption of cereals, milk, and potato/starchy vegetables increased. There was also a decrease in the frequency of drinking tea or coffee, while the consumption of soft drinks remained relatively stable. The level and duration of physical activity significantly decreased among the respondents during the pandemic. This study explored the changes in dietary habits and physical activity among the study population which not only disrupt the metabolic control of the diabetic patients but also pose a significant threat to their overall health. Therefore, it is critical to prioritize measures that support diabetic patients to maintain healthy dietary habit and to engage in regular physical activity during unprecedented times such as COVID-19 pandemic.

737-P: A Wearable Device (CGM and Activity Tracker) RCT for Postpartum Women with a History of Gestational Diabetes—Preliminary Findings on Anthropometry Measures and Self-Reported Lifestyle Behaviours

Background: Women with a history of gestational diabetes mellitus (GDM) have a 7-fold increased risk for subsequent development of type 2 diabetes mellitus (T2DM). Continuous glucose monitoring systems (CGMS) and exercise trackers have not been thoroughly explored in any Asian postpartum diabetes prevention studies. Objective: The Integrated Hyperglycaemia Incentivised Postnatal Surveillance (I-HIPS) study aims to investigate the efficacy of a personalized lifestyle intervention programme using wearables along with physical activity (PA) and diet modification to achieve healthy weight loss in postpartum women with history of GDM. Methods: Women were randomized to receive the intervention or standard medical care. The intervention group received a CGM sensor and exercise tracker, along with nutrition, exercise and personalized goal-setting workshops. Anthropometric measures (weight, BMI and waist circumference (WC)) and PA assessed using the International Physical Activity Questionnaire were examined between the two arms at the 6-month follow-up. Changes in dietary behaviors in the intervention group were assessed using a validated 6P tool. Results: Twenty-six recruited women had completed the 6-month follow-up. At 6-month, compared with the controls, women receiving intervention achieved a mean difference in the reduction of weight by 0.5 kg, BMI by 0.2 kg/m2 and WC by 0.8cm (p>0.05). The intervention group had increased PA (mean difference: +990 MET mins/week), compared to the controls (mean difference: +298 MET mins/week) (p>0.05) at 6-month. Between baseline and 6-month, women in the intervention group showed a reduction in the frequency of snack and beverage intakes (p=0.01). Conclusion: Preliminary findings suggest a trend toward better health outcomes in the intervention group with improved dietary behaviour. Disclosure P.Quah: None. N.Razali: None. S.M.H.Chai: None. F.Fadzully: None. L.W.K.Ryan: None. C.Ku: None. S.Loy: None. K.Tan: None. Funding National Medical Research Council of Singapore (MOH-000504-03)

679-P: Impact of Diabetes Distress on Glycemic Control, Diet Behaviors, and Diabetic Complications in Type 2 Diabetes Mellitus

Background: We investigated the clinical features of patients with high diabetes distress, focusing on changes in glycemic control, dietary behaviors, and risk of diabetic complications. Methods: From the Korean National Diabetes Program data, we investigated 1,862 individuals with type 2 diabetes mellitus (T2DM) who completed the Korean version of the Problem Areas in Diabetes Survey (PAID-K). A total score ≥40 was considered indicative of high distress. Results: Individuals with high distress (n=589) had significantly higher levels of glycated hemoglobin (HbA1c) than those without distress, and this trend persisted for three years. In a subgroup of individuals with HbA1c <6.5% at baseline, patients with high distress were less likely to maintain HbA1c <6.5% after three years of follow-up (41.2% vs. 60.6%, p=0.007). Higher PAID-K scores were associated with younger age, longer duration of diabetes, higher HbA1c level, higher carbohydrate intake, and lower fiber intake (all p<0.05). There was a significant association between high distress and diabetic neuropathy (adjusted odds ratio, 1.63; p=0.002), but no significant association was found with other complications, including retinopathy, albuminuria, and carotid artery plaque. Conclusion: High diabetes distress was associated with uncontrolled hyperglycemia, a high-carbohydrate and low-fiber diet, and higher odds of diabetic neuropathy. Disclosure Y.Cho: None. Y.Kim: None. D.Seo: None. S.Ahn: None. S.Hong: None. S.Kim: None.

Associations Between Changes in Activity and Dietary Behaviors after Metabolic and Bariatric Surgery.

Patients who undergo metabolic and bariatric surgery (MBS) are advised to make healthy activity and dietary changes. While previous research has examined post-surgical changes in activity and dietary behaviors separately, no study has assessed whether changes in these behaviors are beneficially associated with each other. We evaluated whether post-surgical improvements in activity behaviors related to favorable changes in dietary behaviors overall and by surgery type (Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG]). At pre-surgery and 6- and 12-months post-surgery, participants (N = 97; 67 RYGB/30 SG) wore an accelerometer for 7days and completed 24-h dietary assessments on 3days. General linear models assessed associations between pre- to post-surgical changes in activity (moderate-to-vigorous physical intensity activity [MVPA], sedentary time [ST]) and dietary (total energy intake [EI; kcal/day], dietary quality [healthy eating index/HEI scores]) behaviors, with surgery type as a moderator. Participants on average: demonstrated small, non-significant post-surgical changes in MVPA and ST minutes/day (ps > .05); and reported significant post-surgical decreases in EI (p < .001), but no changes in HEI scores (ps > .25). Greater 12-month post-surgical increases in MVPA were significantly associated with greater decreases in EI, but only for RYGB participants (p < .001). Participants reported large decreases in EI, but made minimal changes in other behaviors after MBS. Results suggest greater increases in MVPA could assist with achieving greater decreases in EI, although this benefit appears to be limited to RYGB patients. Additional research is needed to confirm these findings and determine whether activity-dietary behavior associations differ beyond the immediate post-surgical year.

Systematic Review of Easy-to-Learn Behavioral Interventions for Dietary Changes Among Young Adults

IntroductionImproving the diet quality of young adults may support chronic disease prevention. The approaches used and efficacy of promoting small dietary behavior changes through easy-to-learn (ETL) interventions (requiring no more than 1 hour to teach the behavior) among young adults have not yet been systematically reviewed. MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 independent electronic searches across 6 databases were conducted to identify any articles describing ETL interventions among young adults (aged 18–35 years) and reporting dietary intake outcomes. ResultsAmong 9,538 articles identified, 9 studies met eligibility criteria. Five studies reported significant improvement in the selected dietary outcome. Of these, 3 studies used an implementation intentions approach, in which participants were given or asked to write out a simple dietary behavior directive and carry it on their person. Less than half of included studies were rated as positive for overall quality. DiscussionThe available evidence suggests that ETL interventions targeting the dietary behaviors of young adults may be effective in improving dietary intake. Limitations of included studies were lack of follow-up after the intervention period and low generalizability. Implications for Research and PracticeFurther dietary intervention studies targeting young adults should systematically evaluate the efficacy of ETL intervention approaches among diverse samples.

Feasibility and Acceptability of Chatbots for Nutrition and Physical Activity Health Promotion Among Adolescents: Systematic Scoping Review With Adolescent Consultation.

Reducing lifestyle risk behaviors among adolescents depends on access to age-appropriate health promotion information. Chatbots-computer programs designed to simulate conversations with human users-have the potential to deliver health information to adolescents to improve their lifestyle behaviors and support behavior change, but research on the feasibility and acceptability of chatbots in the adolescent population is unknown. This systematic scoping review aims to evaluate the feasibility and acceptability of chatbots in nutrition and physical activity interventions among adolescents. A secondary aim is to consult adolescents to identify features of chatbots that are acceptable and feasible. We searched 6 electronic databases from March to April 2022 (MEDLINE, Embase, Joanna Briggs Institute, the Cumulative Index to Nursing and Allied Health, the Association for Computing Machinery library, and the IT database Institute of Electrical and Electronics Engineers). Peer-reviewed studies were included that were conducted in the adolescent population (10-19 years old) without any chronic disease, except obesity or type 2 diabetes, and assessed chatbots used nutrition or physical activity interventions or both that encouraged individuals to meet dietary or physical activity guidelines and support positive behavior change. Studies were screened by 2 independent reviewers, with any queries resolved by a third reviewer. Data were extracted into tables and collated in a narrative summary. Gray literature searches were also undertaken. Results of the scoping review were presented to a diverse youth advisory group (N=16, 13-18 years old) to gain insights into this topic beyond what is published in the literature. The search identified 5558 papers, with 5 (0.1%) studies describing 5 chatbots meeting the inclusion criteria. The 5 chatbots were supported by mobile apps using a combination of the following features: personalized feedback, conversational agents, gamification, and monitoring of behavior change. Of the 5 studies, 2 (40.0%) studies focused on nutrition, 2 (40.0%) studies focused on physical activity, and 1 (20.0%) focused on both nutrition and physical activity. Feasibility and acceptability varied across the 5 studies, with usage rates above 50% in 3 (60.0%) studies. In addition, 3 (60.0%) studies reported health-related outcomes, with only 1 (20.0%) study showing promising effects of the intervention. Adolescents presented novel concerns around the use of chatbots in nutrition and physical activity interventions, including ethical concerns and the use of false or misleading information. Limited research is available on chatbots in adolescent nutrition and physical activity interventions, finding insufficient evidence on the acceptability and feasibility of chatbots in the adolescent population. Similarly, adolescent consultation identified issues in the design features that have not been mentioned in the published literature. Therefore, chatbot codesign with adolescents may help ensure that such technology is feasible and acceptable to an adolescent population.

Feasibility and acceptability of an evidence-informed digital intervention to support self-management in people with non-alcoholic fatty liver disease: protocol for a non-randomised feasibility study (VITALISE)

BackgroundNon-alcoholic fatty liver disease (NAFLD) represents a spectrum of disease ranging from simple fatty liver to non-alcoholic steatohepatitis, cirrhosis, liver cancer and liver failure. NAFLD affects up to 30–40% of adults in Western countries and is directly linked to overweight and obesity. There are no approved drugs to specifically target NAFLD, therefore weight loss achieved through changes in dietary and physical activity behaviours is the recommended management approach. However, achieving and sustaining weight loss is challenging for patients with NAFLD. We developed a NAFLD-specific digital lifestyle intervention (VITALISE) to target changes in dietary and physical activity behaviours of patients with NAFLD to initiate weight loss and weight loss maintenance. This study aims to evaluate the feasibility and acceptability of VITALISE in a secondary care clinical setting.MethodsA single-centre, one-arm, prospective design will be used to assess the feasibility and acceptability of recruitment, uptake, engagement and completion of VITALISE. Health-related outcomes will be assessed at baseline and 6-months. An interim measure of self-reported weight, physical activity and self-efficacy will be recorded at 12-weeks. Qualitative semi-structured interviews conducted at 6 months follow up will further explore acceptability and feasibility and fidelity of receipt and enactment. The study aims to recruit 35 patients with newly diagnosed NAFLD over a 6-month time period. Eligible patients will have continuous access to VITALISE and monthly tele-coaching support for 6 months prior to follow-up with a hepatologist.DiscussionVITALISE offers access to evidence and theory-informed tailored dietary and physical activity support for patients with NAFLD. The intervention is designed for use by patients in their own time, outside of the hospital setting to overcome well documented challenges including attending additional appointments, and lack of time during routine appointments to adequately address lifestyle behaviour change. This feasibility study will determine the feasibility of VITALISE to support clinical care delivery.Trial registrationISRCTN12893503.

Effects of a smartphone app-based diet and physical activity program for men living with HIV who have dyslipidemia: A pilot randomized controlled trial.

People living with HIV are at a high risk for cardiovascular disease owing to antiretroviral therapy use and chronic inflammation. There is limited evidence on the evaluation of serum lipid levels through lifestyle modification. This study aims to evaluate the effect of a smartphone application-based diet and exercise improvement program on men living with HIV and dyslipidemia. This was a randomized controlled trial recruiting Japanese men living with HIV who have dyslipidemia: intervention group (n = 19) and control group (n = 19). The intervention group received a third individual guidance session during the 6-month intervention and was encouraged to record their diet on a smartphone application. An intention-to-treat analysis of the results was conducted. The intervention group showed significantly reduced change in low-density lipoprotein levels compared to the control group (-4.00 ± 20.2 mg/dL vs. 10.11 ± 21.1 mg/dL) (p = .042) from baseline to 6 months post-intervention. No significant differences were found in other serum lipid levels. Abdominal circumference decreased significantly in the intervention group (p = .048) from baseline to 6 months post-intervention. Total energy, protein, carbohydrate, fat, and salt intake, dietary and physical activity behavior change stages and social support, dietary self-efficacy, and loneliness significantly improved in the intervention group (p < .05) from baseline to 6 months post-intervention. A diet and physical activity improvement program using a smartphone application based on Japanese-specific health guidance may reduce low-density lipoprotein cholesterol levels in this population. Further sample expansion and examination of long-term effects are needed.

A qualitative analysis of denture wearing experience affecting the quality of life of older adults.

To explore how denture-related experiences affect older adults' quality of life using a qualitative assessment of the Oral Health Impact Profile for Edentulous individuals (OHIP-Edent). Twenty elderly individuals were interviewed before and 3months after delivering new complete dentures, using an open-ended interview guide based on the OHIP-Edent. Interviews were audio-recorded and transcribed. Data were open coded and thematically analyzed following a Grounded Theory approach. Findings were integrated and constantly compared to understand the interviewees' difficulties, beliefs, and perceptions. Three interconnected themes were developed: functional and psychosocial impairments, and coping strategies. Even when posed as an open-ended format, the wording of some OHIP-Edent items was confusing while others were not relevant to the respondents. New categories related to speaking, smiling, swallowing, emotional and functional coping emerged from the interviews. Interviewees adapted to chewing and swallowing difficulties through food avoidance, modification of food choice and preparation techniques, and changes in dietary behaviors. Denture wearing is a daily challenging experience that encompasses various functional and psychosocial aspects and sheds light on the need for addressing the coping strategies employed by patients, as the current OHIP-Edent items may not fully represent other deemed important aspects of the quality of life of individuals who wear dentures. Dentists must not solely rely on structured questionnaires to explore the impact of denture wearing and treatment outcomes. Clinicians can use a more holistic approach to comprehend older adults' experiences with dentures including advice about coping mechanisms, food preparation techniques, and meal planning.

395 Effectiveness of Short-term, Home-delivered, Low Sodium Meals to Sustain Long-term Changes in Dietary Behavior in Hemodialysis Patients

395 Effectiveness of Short-term, Home-delivered, Low Sodium Meals to Sustain Long-term Changes in Dietary Behavior in Hemodialysis Patients

Insights from dietitians providing individualised dietetic care to people living with disabilities: A single site exploration in the community.

The present study aims to share insights and lessons learnt by dietitians providing individualised care to people living with disabilities in the community. This is important to build the evidence to inform dietetic best practice standards. The study involved a cross-sectional data audit of dietitian reports for clients living with a disability seen at a metropolitan dietitian clinic in South Australia. Content analysis of the reports was conducted. Initial coding occurred deductively followed by inductive qualitative content analysis. Thirty-one participants consented to have their dietitian reports included in the study. Intellectual disabilities made up the majority (48%) of disabilities reported in the sample. Nutrition diagnoses predominantly related to energy imbalances (54%). Barriers to dietary change included a reliance on others and limitations in the disability support system. Kitchen skills and cooking were the most often employed nutrition strategy suggested by dietitians. Following dietetic intervention, improvements were seen in the types of foods people with a disability consumed along with changes to their body weight. Dietitians reported the importance of effective communication with the care team and providing engaging methods to instigate dietary behaviour change. The present study highlights that there are opportunities to build on individualised dietetic care provided to people living with disabilities. These opportunities include addressing excess energy consumption, fostering collaborations with other health providers and understanding how to better work with carers. Further research is required to understand how to progress these opportunities forward and to understand the generalisability of the findings.

Multisectoral Nutrition Interventions and Their Impact on Pregnancy Weight Gain and Low Birth Weight: An Open Experiment in Two Remote Blocks of Karnataka, India

The Karnataka Multisectoral Nutrition Pilot Project, (KMNPP), 2015–2018, was implemented in Devadurga Block, Raichur District and Chincholli Block, Gulbarga District, two most backward Blocks in Karnataka. Special interventions for behaviour change and appropriate dietary supplementation for pregnant women were implemented through an inter-sectoral, intergenerational strategy. This article analyses real-time data that emerged from the project regarding pregnancy weight gain, the weight of newborns at birth and incidence of low birth weight (LBW), and the inter-relationship between these three indicators. Data indicates that KMNPP interventions resulted in a significant increase in mean pregnancy weight gain from 2.452 kg at baseline to 4.058 kg at end-line. Incidence of LBW declined highly significantly from 34.3% to 25.8% from baseline to end line and the mean birthweight of newborns increased significantly from 2.599 kg to 2.695 kg. Data provides strong evidence of a direct correlation between increased maternal pregnancy weight gain, a decrease in per cent LBW and a corresponding increase in mean birth weight of newborns, as the project interventions progressed. This article also provides strong evidence that simple KMNPP interventions addressing pregnancy nutritional care including appropriate dietary supplementation and behaviour change can be replicated in any chronic undernutrition areas to improve pregnancy weight gain, increase birth weight and reduce the incidence of low birth weight.

A Qualitative Study of Changes in Adolescent Dietary Behavior during the COVID-19 Pandemic and Improvement Strategies for School-Provided Nutrition Counseling

This study utilized qualitative research to understand the changes taking place in adolescent dietary behaviors during the COVID-19 pandemic and the current status of school-provided nutrition counseling. These, along with barriers and strategies for improvement, were derived from focus group interviews with 10 nutrition teachers. Throughout the pandemic, adolescents experienced various dietary problems, including frequent meal skipping, unbalanced diets, increased obesity, and difficulties building positive attitudes towards food. To resolve these dietary problems, nutrition teachers recognized the need for school-provided nutrition counseling. However, nutrition teachers faced various barriers, such as a lack of time for nutrition counseling among students, lack of support from parents, and insufficient space and resources. To revitalize school-provided nutrition counseling, strategies such as home-connected nutrition counseling, the development of standardized guidelines, manuals for school-provided nutrition counseling, software support for nutrition diagnosis, and implementation of nutrition counseling in connection with cooking activities were proposed. This is important as school-provided nutrition counseling can help develop the foundation for healthy dietary behaviors and health promotion in adolescents.

“Ancestral recipes”: a mixed-methods analysis of MyPlate-based recipe dissemination for Latinos in rural communities

BackgroundThe Latinx population experiences some of the highest rates of chronic disease, including obesity and type II diabetes. Such conditions may be especially burdensome in rural Latinx communities that often face barriers to accessing disease prevention resources and public health programs.MethodsDiverse stakeholders (i.e., patients, community members, system of healthcare clinics, community food bank) tailored an existing cookbook, based on the U.S. Department of Agriculture MyPlate healthy eating and dietary guidelines, for local ingredients, health literacy, and language for rural Latinx and Indigenous Latin Americans. The cookbook recipes were disseminated widely via virtual cooking demonstrations, food distribution events, and social media. Pre- and posttest surveys were used to assess changes in diabetes knowledge measured by the 24-item American Diabetes Association Diabetic Knowledge Questionnaire and confidence in dietary behavior change over time measured by 4 questions of the 17-item Mediterranean Diet Index. A mixed effects, repeated measures analysis was conducted with gender ID, age range and educational attainment included as covariates and assessment interval as the predictor (pretest vs posttest) and change in confidence about adhering to four specific components of the Mediterranean diet. Focus groups elicited information on participants’ motivation and ability to use the recipes and eat healthy foods following the virtual cooking demonstration participation.ResultsA total of 20 virtual cooking demonstrations were conducted and 60 participants completed a pretest survey and 54 a posttest survey, a subsample (n = 19) participated in one of three focus groups. Most participants were female, identified as Latinx/Hispanic, were between the ages of 40-49, and spoke Spanish. 17% identified as Indigenous Latin American specifically as Purépecha, an indigenous group from Michoacán, Mexico. Survey and focus group findings indicated at posttest an increase in diabetes knowledge among participants with no prior diagnosis of chronic health conditions and more confidence in limiting sugary beverages and refined wheat pasta/white rice among indigenous participants. Focus group discussions explicated the quantitative findings.ConclusionThis study brought together patients and key stakeholders committed to addressing the social determinants of health and it mobilized the community to develop culturally vetted health education materials. The findings indicate the need for increased access to evidence-based nutrition education and to culturally appropriate food products that can be easily incorporated into daily food preparation.

Evaluating the healthfulness of Asian American young adult dietary behaviors and its association with family structure: Disaggregated results from NHIS 2015.

Background: Asian Americans (AA) young adults face a growing non-communicable disease burden linked with poor dietary behaviors. Family plays a significant role in shaping the diet of AA young adults, although little is known on the specific types of family structures most associated with different dietary behaviors. Aim: This analysis explores the changes in dietary behaviors across different AA young adult family structural characteristics. Methods: Nationwide data of 18-35-year-old self-identified Asians surveyed in the 2015 National Health Interview Survey (NHIS) was analyzed. Family structure was measured through family size, family health, and family members in one's life. The Dietary Screener Questionnaire (DSQ) measured the average intake of 10 food and nutrient groups. Published dietary guidelines were used to calculate the number of dietary recommendations met. Results: 670 AA young adults with dietary data were analyzed (26.1% Asian Indian, 26.1% Chinese, 19.3% Filipino, 28.5% other Asian). Participants had an average family size of 2.3. In weighted analyses, 19% of AA young adults met none of the examined dietary recommendations, and only 14% met 3-4 guidelines. Living with a child was associated meeting more dietary recommendations (adjusted odds ratio [AOR]: 1.22; 95%CI: 1.05, 1.42). The adjusted association between living with an older adult and lower odds of meeting dietary recommendations approached significance (AOR: 0.70; 95%CI: 0.49, 1.00). Conclusions: Findings revealed the important role of children and older adults in influencing the diet of AA young adults. Further mixed-methods research to disentangle mechanisms behind the influence of family structure on diet is warranted.

Effects of a One-Week Intensive Wellness Camp on Dietary Behaviors among Southwest American Indian Youth

American Indians (AI) suffer the highest rates of diabetes in the United States (US); a chronic disease that is increasingly prevalent among AI children and is associated with increased risk of cancer. A summer camp was developed to improve disease risk-reducing behaviors, including diet, among AI youth in Arizona. The aim of this study was to examine the efficacy of a one-week intensive summer health camp conducted from 2016 to 2019 on change in dietary behaviors and compliance for Dietary Guidelines for Americans (DGA) among AI youth. AI children aged 10 to 15 years from several Arizona tribes participated in one-week intensive residential camps. Participants engaged in a week of experiential learning focused on healthy eating and physical activity. Twenty-four hour dietary recalls were collected from AI youth by trained staff six weeks before and six weeks after camp. T-tests were conducted to analyze differences in mean intake pre-and post-camp. Diet recalls for 45 children (boys = 19, girls = 26) were included in the current analysis. Results showed a statistically significant reduction in median intake of total fat by 19.5% (P-value = 0.01), and saturated fat by 14.9% (P-value = 0.01). Further, a statistically significant decrease in median energy intake of 18.7% (P-value = 0.002), a 22.9% decrease in total fat (P-value = 0.01), and 22.3% reduction in saturated fat was observed among boys only. However, post-camp, a higher percentage of girls met guidelines for fruit intake (54% vs 26%), percent saturated fat (23% vs 16%), calcium (7% vs 0%) and whole grains (15% vs 0%), while a higher percentage of boys met guidelines for vegetables (63% vs 50%) and sodium (25% vs 23%). The AI health camp was effective at reducing energy intake (kcals/day), total fat (g/day) and saturated fat (g/day) among participants aged 10 to 15 years. The camp was observed to be more effective at decreasing energy, total fat, and saturated fat intake among boys.