Community Nutrition Interventions Research Articles

Achieving Healthy Body Weight in Teenagers: Evidence-based Practice Guidelines for Community Nutrition Interventions

An evidence-based review of research on obesity prevention and treatment in youth was conducted to identify successful elements of community nutrition interventions. Guidelines for dietetic practice appropriate to this age group were synthesized. Following a systematic review of English-language research papers published from 1996 to 2009, 63 interventions met inclusion criteria and were graded according to methodological quality, quantity, consistency, and reproducibility. They also were analyzed for common themes and used to develop guideline statements and a practice algorithm. A national panel of experts in community nutrition, public health, adolescent health, academia, and endocrinology assessed the guidelines and the practice algorithm for validity, acceptability, and applicability. Successful prevention strategies are comprehensive, address social and environmental influences, include nutrition education and physical activity, and use schools as a health promotion delivery venue. Computer- or technology-based and peer-modelling strategies are promising, developmentally appropriate approaches. Effective obesity treatment strategies utilize diet plans and behaviour modification techniques, and involve families in intensive, multidisciplinary interventions. Given the distinct needs of this age group, healthy body weight must be promoted through a comprehensive school-based approach. In summary, obesity prevention and treatment interventions should be comprehensive, multidisciplinary, and developmentally appropriate.

Achieving Healthy Body Weight in Teenagers: Evidence-based Practice Guidelines for Community Nutrition Interventions

Achieving Healthy Body Weight in Teenagers: Evidence-based Practice Guidelines for Community Nutrition Interventions

Effectiveness of a Pilot Community Physical Activity and Nutrition Intervention in American Samoa

Background: The addition of Western foods to the Samoan diet has greatly affected the health of the American Samoan people. The purpose of this study was to test the effectiveness of culturally tailored exercise and nutrition interventions for adults living in Tutuila, American Samoa. Method: Villages in the eastern, central, and western parts of the island of Tutuila were recruited to participate in this study. Villages were randomly assigned to one of three culturally tailored interventions: 46 individuals in one village participated in an exercise intervention, 27 individuals in another village participated in a nutrition-education intervention, and 22 individuals in a third village participated in a combined exercise and nutrition-education intervention. Participants’ nutrition knowledge was measured at pre- and post-intervention stages through a questionnaire. Body Mass Index (BMI), height, and weight were assessed at baseline and again at weeks 4, 8, and 12. Differences in mean BMI over time by group, were assessed using repeated measures ANOVA with baseline BMI as a covariate. To test for differences in nutrition knowledge over time by group, pair-wise comparisons were used for the percent of correct answers at baseline and at week 12. Results: All three groups realized a significant decrease in BMI, from 1.35 in the nutrition only group to 2.27 in the exercise and nutrition group. The exercise and nutrition group also showed significant gains in ability to identify foods high in fiber and fat. Implications: This study demonstrates that decreases in BMI and increases in nutritional knowledge can be obtained through a culturally-tailored intervention, especially one that combines nutrition education and exercise.

Evaluation of a Community Nutrition Intervention to Decrease Hypertension Risk

Culturally-appropriate interventions for decreasing dietary risk factors for hypertension are important in reducing morbidity and mortality. The purpose of the Hypertension Education Risk Reduction study was to evaluate a community-based nutrition intervention to decrease dietary risk factors for hypertension in a low-income population.

Obesity and the Metabolic Syndrome in Developing Countries

Prevalence of obesity and the metabolic syndrome is rapidly increasing in developing countries, leading to increased morbidity and mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular disease. Literature search was carried out using the terms obesity, insulin resistance, the metabolic syndrome, diabetes, dyslipidemia, nutrition, physical activity, and developing countries, from PubMed from 1966 to June 2008 and from web sites and published documents of the World Health Organization and Food and Agricultural Organization. With improvement in economic situation in developing countries, increasing prevalence of obesity and the metabolic syndrome is seen in adults and particularly in children. The main causes are increasing urbanization, nutrition transition, and reduced physical activity. Furthermore, aggressive community nutrition intervention programs for undernourished children may increase obesity. Some evidence suggests that widely prevalent perinatal undernutrition and childhood catch-up obesity may play a role in adult-onset metabolic syndrome and T2DM. The economic cost of obesity and related diseases in developing countries, having meager health budgets is enormous. To prevent increasing morbidity and mortality due to obesity-related T2DM and cardiovascular disease in developing countries, there is an urgent need to initiate large-scale community intervention programs focusing on increased physical activity and healthier food options, particularly for children. International health agencies and respective government should intensively focus on primordial and primary prevention programs for obesity and the metabolic syndrome in developing countries.

Achieving healthy body weights in the teenage years: evidence-based practice guidelines for community nutrition interventions

Achieving healthy body weights in the teenage years: evidence-based practice guidelines for community nutrition interventions

The Eating Behavior Patterns Questionnaire predicts dietary fat intake in African American women

Objective To develop a behavioral assessment of eating that would be predictive of fat intake in African American women. Design Questionnaires were developed using a three-stage design, involving item generation, item refinement, and questionnaire validation. Subjects Focus groups sessions were conducted with 40 African American women, initial questionnaire development employed 80 African American women, and questionnaire validation involved 310 African American women from diverse socioeconomic backgrounds. Statistical analyses Transcripts of focus groups were used to generate 113 behavioral questionnaire items. The initial questionnaire was administered along with a food frequency questionnaire, and the item pool was reduced to 51 items. Factor analysis was used to create subscales. Correlation (r) and multiple regression analysis (R) were used to evaluate construct validity. Results Factor analysis revealed six subscales: low-fat eating, emotional eating, snacking on sweets, cultural/ethnic, haphazard planning, and meal skipping. The scales are significant predictors of micronutrient (R values from 0.22 to 0.47) and macronutrient intakes (R values from 0.33 to 0.58) assessed using a food frequency questionnaire and show construct validity in relationship to other measures of eating behavior (r values from 0.22 to 0.65). Applications The Eating Behavior Patterns Questionnaire (EBPQ) may be a useful tool for clinical assessment, clinical and community nutrition intervention studies, and epidemiologic research with African American women. J Am Diet Assoc. 2003;103:338-345.

The Eating Behavior Patterns Questionnaire predicts dietary fat intake in African American women*1

Objective To develop a behavioral assessment of eating that would be predictive of fat intake in African American women. Design Questionnaires were developed using a three-stage design, involving item generation, item refinement, and questionnaire validation. Subjects Focus groups sessions were conducted with 40 African American women, initial questionnaire development employed 80 African American women, and questionnaire validation involved 310 African American women from diverse socioeconomic backgrounds. Statistical analyses Transcripts of focus groups were used to generate 113 behavioral questionnaire items. The initial questionnaire was administered along with a food frequency questionnaire, and the item pool was reduced to 51 items. Factor analysis was used to create subscales. Correlation (r) and multiple regression analysis (R) were used to evaluate construct validity. Results Factor analysis revealed six subscales: low-fat eating, emotional eating, snacking on sweets, cultural/ethnic, haphazard planning, and meal skipping. The scales are significant predictors of micronutrient (R values from 0.22 to 0.47) and macronutrient intakes (R values from 0.33 to 0.58) assessed using a food frequency questionnaire and show construct validity in relationship to other measures of eating behavior (r values from 0.22 to 0.65). Applications The Eating Behavior Patterns Questionnaire (EBPQ) may be a useful tool for clinical assessment, clinical and community nutrition intervention studies, and epidemiologic research with African American women. J Am Diet Assoc. 2003;103:338-345.

Gender, family, and the nutritional status of children in three culturally contrasting states of India

This paper has three main aims: to measure the clustering of children with low weight for age z-scores within families, to establish whether significant differences exist by gender in weight for age z-scores, and to demonstrate whether the presence of a mother-in-law in the household has any significant impact on the nutritional status of young children. Regression modelling is used to examine the weight for age z-scores of children under the age of four years in Maharashtra, Tamil Nadu and Uttar Pradesh using the 1992–93 Indian National Family Health Survey data. Random effects models measure the clustering of children with low weight for age z-scores in families, controlling for a number of other family factors. Our findings do not reveal significant gender differences in weight for age z-scores. Although little variation was found between family structures in the nutritional status of children, there were significant differences between families after controlling for family type. This suggests that there are differences between families that cannot be explained by a cross-sectional demographic survey. The evidence from this work suggests that nutrition programs need to adopt community nutrition interventions that aim resources at young children from families where children with low weight for age z-scores are found to cluster. However, there is a need for further inter-disciplinary research to collect data from families on behavioural factors and resource allocation in order that we might better understand why some families are more prone to having children with low weight for age z-scores. The diversity in the significant covariates between the three states in the models has shown the need for Indian nutrition programs to adopt state-specific approaches to tackling malnutrition.

Community nutrition intervention strategies for cancer risk reduction

As the accumulated evidence continues to indicate a need for Americans to modify current eating patterns and other lifestyle factors to reduce the risk of chronic diseases, the demand for community nutrition interventions will accelerate. All interventions require certain basic elements, such as measurable objectives and robust evaluation designs. However, there are other overarching strategies whose application will contribute to the research knowledge base for community interventions. This article focuses on three such strategies: use of the national health objectives, use of community channels, and development of interventions based on theories of health behavior. The application of these strategies to the National 5 A Day for Better Health Program is illustrated.

Validation of a self-reported shelf inventory to measure food purchase behavior

A mailed, self-reported shelf inventory was validated for use as a tool in assessing the impact of a community nutrition intervention that included a point-of-purchase component. The self-reported inventory was evaluated for overall accuracy as well as for the effects of gender, age, and shopping responsibility on accuracy. In addition, the food-shelf inventory was compared with a specific food frequency questionnaire. Specificity and sensitivity were calculated for self-reported inventories using an interviewer-completed, same-day inventory as the gold standard. Overall sensitivity was 86% and 87%, and overall specificity was 92% and 90% in two validation studies. Results show that the mailed, self-reported shelf inventory is a valid measure of the presence or absence of particular foods in households. As such, it may be a useful tool for assessing the impact of point-of-purchase nutrition interventions.

Development and validation of a food use checklist for evaluation of community nutrition interventions.

We developed a new dietary assessment instrument, the Food Behavior Checklist (FBC), which measures food use related to adopting lower-fat and higher-fiber diets. The FBC is a simplification of the 24-hour diet recall that consists of 19 simple yes/no questions about foods consumed during the previous day. To develop the FBC, an expert committee generated a list of foods based on our intervention program, and we used focus groups and random-digit dialing pretests to refine the format and clarify items. To validate the FBC, we compared responses of 96 women on the FBC to information collected during a professionally administered 24-hour diet recall. For most items, agreement between the FBC and 24-hour recall, based on the kappa statistic, was good to excellent. Agreement was poor for items requiring detailed knowledge about food composition (e.g. high-fiber cereal). There was a trend to over-report general food categories (e.g. luncheon meats) but not specific food items (e.g. ice cream). In an embedded randomized study, we found that a set of introductory items designed to serve as a memory retrieval cue did not improve agreement between the FBC and 24-hour recall. These data provide preliminary evidence supporting the use of short checklist questionnaires on the previous day's food use as a means to assess diet at the group or community level. This relatively inexpensive and rapid measure can be used to inform the design of public health nutrition programs and as an evaluation tool in intervention research.

Developing nutrient criteria for food-specific dietary guidelines for the general public

Consumers are asking for specific information about which foods and, in particular, which brands of packaged foods to choose when they eat or purchase food. Point-of-purchase nutrition intervention programs that identify specific foods in restaurants and grocery stores are particularly promising community-based strategies for providing that type of information. However, such strategies demand consistent criteria for determining which foods and/or products should be labeled. This article describes the process of developing and validating criteria and the subsequent uses of the criteria in community nutrition intervention programs. Steps in the process include (a) identifying the scientific basis for the criteria, (b) developing food-group-specific nutrient criteria based on a referent meal pattern, (c) developing the eligibility of single servings of specific foods for labeling based on the nutrient criteria of the food group to which the specific food belongs, and (d) validating the criteria by reviewing actual food products in the grocery stores and restaurants. We conclude that the use of criteria provides a consistent standard for evaluating specific foods and food items in nutrition evaluation programs.

Diet and chronic disease issues for minority populations

The Report of the Task Force on Minority Health (110), released in 1985 and 1986, signaled a new era of awareness of the unique health and disease profiles of raciaVethnic minority groups in the United States (1-10). Many minority health issues remain to be clarified; however, the need for special attention to the health problems of minority groups is no longer debated. This paper highlights minority health issues related to diet and chronic disease. The objective is to draw attention to the different chronic disease morbidity and mortality patterns among minority populations and to highlight particular areas of excess risk. Implications for community nutrition interventions are discussed.