Dietary Health Behaviors Research Articles

Whole Food Plant-Based Dietary Education for Frontline RNs

Background: Coronary artery disease (CAD) is the leading cause of death for men and women in the United States, with myocardial infarction (MI) being a serious outcome. Plant-based diets are associated with a reduced incidence of CAD. Registered nurses (RNs) are highly trusted members of the healthcare team and are ethically responsible for providing reliable information based on scientific sources and guideline-directed recommendations. Registered nurses are optimally positioned to provide education on adopting whole foods plant-based (WFPB) diets to patients experiencing CAD inside and outside the hospital setting. It is unknown the degree to which nurses have adopted WFPB eating patterns and incorporated WFPB patient education into routine nursing care. The purpose of this study is to describe RN perceptions (susceptibility, severity, benefits and barriers, self-efficacy) related to the effect of a WFPB meal pattern for prevention and management of CAD, and RN intention to apply this dietary knowledge to their own health behaviors and nursing practices. Methods: This descriptive quasi-experimental pretest-posttest study measured concepts from the health belief model including RN perceptions of susceptibility, severity, benefits, and barriers, as well as self-efficacy and meal behaviors. The participating RNs completed these measures before and after they participated in any of the educational interventions designed using experiential learning theory. Registered nurses had the option of attending one or all three educational interventions on WFPB nutrition and CAD. Results: Eighty-six RNs working in cardiology specialties on three inpatient or one outpatient cardiac units at a large southeastern hospital system participated. The nurses believed CAD is a serious diagnosis (72/72) and that WFPB dietary patterns are cardioprotective for the prevention and management of CAD (63/72). However, nurse dietary behaviors were incongruent with their beliefs as some RNs (14/72) indicated they did not consume any vegetarian or fully plant-based meals. The most common barrier (36/72) to nurses adopting a WFPB dietary pattern was a taste preference for meat and animal products. Half of the eight nurses who completed at least one of the educational interventions and the postsurvey reported increased confidence to advise patients with CAD on the WFPB dietary pattern. Combined, participants self-reported their vegetarian or fully plant-based meal frequency increased slightly. Discussion: Registered nurses lack a working knowledge of WFPB eating patterns in their personal and professional lives, which may impact the quality of dietary education they provide to people with CAD or MI. Overcoming barriers to education on WFPB dietary patterns is important for increasing nurse confidence in teaching people with CAD about this evidence-based dietary health behavior. Conclusion: Registered nurses’ knowledge and perceptions of WFPB eating patterns may be enhanced through professional development activities. RNs may be more likely to engage with education that is frequent, brief, asynchronous, and online or part of existing onboarding such as lunch and learn events to sample WFPB foods. Future research is needed on strategies to engage and empower RNs to educate people with CAD on WFPB nutrition.

Association between nutrition self-efficacy, health locus of control and food choice motives in consumers in nine European countries.

We investigated associations between food choice motives and psychological determinants of dietary health behaviour change (nutrition self-efficacy, NS-E, and health locus of control, HLoC) among 9381 participants (18-65 years, 49.4% females) from nine European countries. Price was the highest rated food choice motive. Higher importance of all motives was associated with higher NS-E and with higher Internal HLoC. Relationships between food choice motives and External HLoC were also in the expected direction in showing negative associations with Health, Natural Content, Weight Control, Mood and Sensory Appeal. Higher External HLoC was also associated with perceived greater importance of 'external' motives Ethical Concern, Familiarity and Convenience. Relationships between External HLoC and food choice motives were not all in the expected direction. Price was unrelated to External HLoC. Females rated the importance of all motives higher than males. People with less education ascribed greater importance to Price in motivating food choices. Together, these findings imply that self-efficacy and health locus of control should be considered along with motivations for food choice in dietary health promotion.

Associations Between Health Behaviors, Gastrointestinal Symptoms, and Gut Microbiota in a Cross-Sectional Sample of Cancer Survivors: Secondary Analysis from the Chemo-Gut Study.

Health behaviors, such as diet and exercise, are actions individuals take that can potentially impact gastrointestinal (GI) symptoms and the gut microbiota. Little is known about how health behaviors impact GI symptoms and the gut microbiota after anti-cancer therapies. This is a secondary analysis of a cross-sectional study that investigated relationships between GI symptoms, gut microbiota, and patient-reported outcomes in adult cancer survivors. Gut microbiota was assessed from stool samples using 16 S rRNA gene sequencing. GI symptoms and health behaviors were measured via self-report. Descriptive statistics, multiple regression, and correlation analyses are reported. A total of 334 cancer survivors participated, and a subsample of 17 provided stool samples. Most survivors rated their diet as moderately healthy (55.7%) and reported engaging in low intensity exercise (53.9%) for ≤5 h/week (69.1%). Antibiotic use was associated with more belly pain, constipation, and diarrhea (P < .05). Survivors consuming a healthier diet had fewer symptoms of belly pain (P = .03), gas/bloating (P = .01), while higher protein consumption was associated with less belly pain (P = .03). Better diet health was positively correlated with Lachnospiraceae abundance, and negatively with Bacteroides abundance (P < .05). Greater exercise frequency positively correlated with abundance of Lachnospiraceae, Faecalibacterium, Bacteroides, Anaerostipes, Alistipes, and Subdoligranulum (P < .05). Results provide evidence for associations between antibiotic use, probiotic use, dietary health behaviors, and GI symptoms. Diet and exercise behaviors are related to certain types of bacteria, but the direction of causality is unknown. Dietary-based interventions may be optimally suited to address survivors' GI symptoms by influencing the gut microbiota. Larger trials are needed.

"Mars Bar and a Tin of Red Bull Kept Me and My Patients Alive": Exploring Barriers to Healthy Eating through Facebook Comments of Shiftworkers.

The negative impact of an unhealthy diet on the shiftworker population has been well-documented. However, little evidence exists on the underlying reasons for unhealthy eating behaviours and the existing barriers to healthy eating withinshiftwork environments. This qualitative study investigated the dietary behaviours reported by shiftworkers through Facebook comments. Comments were collected if they were on public shiftworker-relevant posts pertaining to dietary news or dietary information on Facebook and were posted by self-identified shiftworkers, relatives of shiftworkers, or partners of shiftworkers. A thematic analysis of the 144 comments collected generated four categories that can be used to understand the motivations for eating behaviour on-shift: what shiftworkers eat, where food is sourced from, when food is eaten, and why certain foods are chosen. Results reveal motivations, attitudes, and both internal and external barriers to healthy eating behaviours, as well as similarities and differences across shiftwork industries. Recommendations for future research include further explorations on the link between scheduled eating (e.g., time-restricted eating) and shiftwork, the impact of a rotating shift arrangements on dietary health behaviours, and the impact of interpersonal relationships on shiftworker dietary choices. Understanding these motivations will inform strategies to promote healthy eating and help understand barriers for shiftworkers.

Emotional Eating and Diet-related Self-Efficacy, Motivation, and Norms in Adolescents

The objective of the current study was to examine the association between emotional eating and self-efficacy, motivation, and social norms for consumption of fruits and vegetables (F/V) and energy-dense, nutrient-poor (EDNP) foods and beverages, as well as interactions with body mass index-z score (BMI-z). Adolescents completed self-report measures of demographics, emotional eating, and dietary health behavior theory constructs. Emotional eating was associated with lower self-efficacy for consumption of F/V and for limiting EDNP foods/beverages; greater motivation for limiting of EDNP foods/beverages; lower social norms for consumption of F/V; and greater social norms for consumption of EDNP foods/beverages. There were no interactions with BMI-z. Evidence-based nutrition programs that leverage health behavior theories should be tailored to adolescents’ emotional eating.

Stroke Survivor Recommendations for Physical Activity and Dietary Health Behavior Intervention

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Physical activity and dietary-related behaviors are important for enhancing health and quality of life among adults with stroke, yet the prevalence of these healthy behaviors is low. In this qualitative study, adults with stroke identified how stroke-related physical, cognitive, and sensory deficits impact performance of these healthy behaviors and identified specific adaptive and accessible equipment and compensatory strategies for overcoming these barriers that can be utilized in clinical practice. Primary Author and Speaker: Ryan Bailey Contributing Authors: Jennifer Stevenson

Dietary Habits and Anthropometric Measures of a Dental Student Population

Introduction: Health professionals are expected to understand the relationship between diet and nutrition and overall health. Many relationships between oral health and diet and nutrition are known to contribute to health or disease development. However, few studies to date have evaluated the current dietary habits and behaviors of dental students in the United States. The objective of this study was to complete a longitudinal study of diet and exercise behaviors among dental students during their academic experience at UNLV SDM.&#x0D; Methods: Using and Institutional Review Board (IRB) approved protocol, students in four dental cohorts were asked to take a survey regarding their dietary behaviors, nutrition intake and exercise. A total of n=302/327 students participated, yielding an overall response rate of 92.3%. Self reported age, ethnicity and body mass index (BMI) were also collected.&#x0D; Results: A total of n=302 students completed the survey, for an overall response rate of 92.3% (n=302/327). Males represented 57.9% of respondents, which closely matched the overall percentage of males among the student population overall (56%, P=0.6870), while the percentage of minority respondents in the study sample (58.9%) was slightly higher than in the overall student population (51.6%, P=0.1095). Self-reported height and weight were higher among males (as expected) – although body mass index (BMI) measuring the ratio of height-to-weight was lower for females (24.53 +/- 4.65) than males (26.15 +/- 3.84), P=0.3711. To determine if dietary factors may account for these differences both positive dietary health behaviors (fruit and salad consumption) and negative health behaviors (processed snacks and sugar sweetened beverages) were assessed. Females reported higher consumption of fruits and salads (P=0.0131) and lower consumption of processed foods and snacks (P=0.0114) than males. However, analysis of exercise found that males reported more sessions of physical activity per week than females (P=0.023) and also reported more overall minutes of vigorous exercise (P=0.002).&#x0D; Conclusion: Although many populations face significant dietary and related behavioral challenges, medical and dental students face particular stress and time-limited challenges that may negatively influence positive health outcomes. In addition, the perceived clinical relevance of nutrition education may impact future dietary and nutrition-related discussions and provider recommendations. This is among the first dietary studies of self-reported dental student dietary patterns and health behaviors, which demonstrates areas for education and improvement may be needed to increase student wellness, overall health and well-being - as well as targeted points for clinical education that might increase the perceived relevance of dietary and nutrition education.

Motivational Interviewing and Fat Consumption in Older Adults: A Meta-Analysis.

Diets high in fat increase the risks for obesity and chronic diseases, even for older adults, the largest growing population in the United States. In the current study, a meta-analysis was performed to examine the effects of motivational interviewing (MI) dietary interventions on fat consumption in older adults. Electronic databases, journals, and unpublished literature were searched. Six primary studies were retrieved, providing seven comparisons between intervention and control groups and a total of 1,351 participants. MI had a moderate effect on fat intake in older adults (effect size = 0.354, p < 0.01). Studies with indicators of higher design quality showed greater MI effects. Nurses and providers can incorporate MI into health education and counseling to improve older adults' dietary health behaviors. [Journal of Gerontological Nursing, 44(11), 33-43.].

Estimating the effects of nutrition label use on Canadian consumer diet‐health concerns using propensity score matching

AbstractThe overarching goal of nutrition labelling is to transform intrinsic credence attributes into searchable cues, which would enable consumers to make informed food choices at lower search costs. This study estimates the impact of nutrition label usage on Canadian consumers’ (n = 8,114) perceived diet‐health concerns using alternative propensity score matching (PSM) techniques. We apply a series of tests and sensitivity analyses to overcome issues of endogeneity and selection bias frequently found in studies of diet‐health behaviour and to validate the impact of exposure to nutrition facts labels for users vs. non‐users. Our results support the notion that consumer uncertainty and related food‐health concerns are linked to their information behaviour, but not in straightforward manner. Dominant subjective food attributes, such as taste, convenience and affordability, may in fact outweigh the benefits of information about healthier, alternative food choices. In order to change dietary health behaviour, food manufacturer and policy makers alike need to adopt communication instruments that better account for differences in preferences, shopping habits and overall usage patterns of nutrition labelling information.

Dietary health behaviour and beliefs among university students from 26 low, middle and high income countries.

The aim of this study was to assess the prevalence of six healthy dietary behaviours and associated factors in university students from 26 low, middle and high income countries. In a cross-sectional survey, we used a self-administered questionnaire (largely based on the European Health and Behaviour Survey) among 19503 undergraduate university students (mean age 20.8, Standard deviation=2.8, age range of 16-30 years) from 27 universities in 26 countries. Results indicated that for a total of six healthy dietary behaviours, overall, students scored a mean of 2.8 healthy dietary behaviours. More female than male students indicated healthy dietary behaviours. In multivariate linear regression among men and women, living in an upper middle income or high income country, dieting to lose weight, the high importance of dietary health benefits, high non-organized religious activity, high physical activity and currently a non-tobacco user were associated with the healthy dietary behaviour index. The study found a high prevalence of relatively poor dietary healthy behaviours.

Dietary Health Behaviors of Women Living in High Rise Dwellings: A Case Study of an Urban Community in Malaysia

Diet-related non-communicable disease (DR-NCD) occurrence is a serious problem amongst Malaysian women and urbanization is probably a challenge to their achieving the nutritional environment conducive to healthy eating. This case study aimed to determine diet quality of an urban community using women respondents from high rise dwellings in Kuala Lumpur. The sample consisted of 135 households and a healthy eating index (HEI) scale was used to evaluate the women’s diet quality. A total of 128 women (Malays = 45, Chinese = 56, Indian = 27) participated. Total HEI score was significantly different (P < 0.05) within ethnicity (Indians = 75.7 ± 8.1 <Malays = 80.5 ± 7.4 <Chinese = 80.1 ± 8.1) and affected by component scores for fruit (range 3.8–6.2, P = 0.044), sodium (range 7.8–9.0, P = 0.006) and food variety (range 9.3–9.9, P = 0.001). Dairy foods rated poorly (range 2.0–3.9, P > 0.05) regardless of ethnicity. Income strata (ρ = 0.159, P = 0.048) and eating out frequency (ρ = −0.149, P = 0.046) also independently affected HEI scores. Income negatively correlated with sodium restriction score (ρ = −0.294, P = 0.001) but positively with cereals (ρ = 0.181; P = 0.025), fruits (ρ = 0.178; P = 0.022), dairy products (ρ = 0.198; P = 0.013) and food variety (ρ = 0.219, P = 0.007). Decreased vegetable intake (ρ = −0.320; P < 0.001) and sodium excess (ρ = −0.135, P = 0.065) were associated with eating out frequency and poor HEI scores. This case study suggests health promotion for DR-NCD prevention is needed at the community level to improve diet quality of urban women.

The Health Action Process Approach as a Motivational Model of Dietary Self-Management for People With Multiple Sclerosis

The main objective of this study was to evaluate the health action process approach (HAPA) as a motivational model for dietary self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis was used. Participants were 209 individuals with MS recruited from the National MS Society and a neurology clinic at a university teaching hospital in the Midwest. Outcome was measured by the Healthy Dietary Stages of Change Instrument, along with 10 predictor measures. The HAPA dietary self-management model fit the data relatively well (goodness-of-fit index = .95, normed fit index = .90, comparative fit index = .95, and root mean square error approximation = 0.07) explaining 15% of the variance in dietary self-management behavior. Recovery self-efficacy and action and coping planning directly contributed to the prediction of dietary health behaviors. Action self-efficacy, outcome expectancy, risk perception, and social support influenced intention, and the relationship between intention and dietary health behaviors is mediated by action and coping planning. Action self-efficacy, maintenance self-efficacy, and recovery self-efficacy directly or indirectly affected dietary health behaviors. Empirical support was found for the HAPA model of dietary self-management for people with MS. The HAPA model can be used to design behavioral health promotion interventions for people with disabilities in vocational rehabilitation.

Commitment to health: a predictor of dietary change

To determine the predictive validity of three behavioural variables on changes in diet: commitment to health (commitment), confidence in ability to change dietary behaviours (confidence) and belief about the importance of changing dietary behaviours (importance). Literature supports the Transtheoretical Model of Behavior Change as a framework for understanding dietary behaviour change. Less certain are behavioural variables associated with stage movement for action to maintenance stage for dietary behaviour change. This research considered three variables: self-efficacy ('confidence'), decisional balance scale ('importance') and 'commitment'. Published literature supports the importance of each of these behavioural variables, but not their predictive abilities. A cross-sectional survey was used for 499 manufacturing workers from multiple work-sites. Subjects' dietary health behaviours were measured by determining how long they consistently ate a low-fat diet, with analysis of variance addressing the stages-of-change model: precontemplation, contemplation, preparation, action, maintenance. Commitment best predicted change from action to maintenance stage (p < 0·05). Importance (p < 0·05) was somewhat significant, but confidence (p > 0·05) was not. Commitment was the best predictor of dietary change, from the action to the maintenance stage of change. Clinicians working with patients in the action stage of dietary change can use a stage-based approach and should evaluate commitment to health as part of an overall assessment. Those with high-level commitment will successfully change from action to maintenance with minimal professional assistance. Those with middle-level commitment risk relapse to a pre-action stage will benefit most from professional intervention. Those in the lower level of commitment are most likely to revert to a pre-action stage of change and may be not be ready for dietary change.

Randomized trial of a low-intensity dietary intervention in rural residents: The Rural Physician Cancer Prevention Project

Dietary behavior, specifically a low-fat, high-fiber diet, plays a role in the primary prevention of chronic diseases including cancer.A community-based randomized trial to assess the impact of a low-intensity, physician-endorsed, self-help dietary intervention that provided tailored dietary feedback, and was designed to promote improved fat and fiber behavior in a rural, low-education/low-literacy, partly minority population. The data were collected from 1999 to 2003.A total of 754 patients from three physician practices in rural Virginia completed a baseline telephone survey assessing dietary and psychosocial information, and were then randomly assigned to the intervention or control condition. Follow-up telephone evaluation was based on 522 participants at 1 month, 470 at 6 months, and 516 participants at 12 months.A series of tailored feedback, followed by brief telephone counseling and theory-based nutritional education booklets, provided by staggered delivery to the home.Dietary fat and fiber behavior, dietary intentions to change, self-efficacy for dietary change, and fat and fiber knowledge.The intervention group demonstrated significant improvement in dietary fat and fiber behaviors and intentions to change fat and fiber intake (p <0.05) at 1, 6, and 12 months.The Rural Physician Cancer Prevention Project provides an effective model for achieving public health-level dietary health behavior changes among a rural, minority, and low-literacy/low-education population.

Occupational social class, educational level and area deprivation independently predict plasma ascorbic acid concentration: a cross-sectional population based study in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk).

To investigate the independent association between three different measures of socioeconomic status and plasma ascorbic acid level. Cross-sectional population based study. 20 292 men and women aged 39-79 y who participated in the EPIC-Norfolk study. Individuals in manual social classes, who had no educational qualifications or those who lived in the most deprived areas had significantly lower levels of plasma ascorbic acid compared to those in nonmanual social classes, with at least O-level qualifications or who lived in less deprived areas. The magnitude of effect for each measure of socioeconomic status was greater in current smokers compared to current nonsmokers. Education and social class were stronger predictors of differences in ascorbic acid levels, an indicator of dietary health behaviour, than a deprivation index based on the Townsend score. This suggests that education could be particularly important in influencing large socioeconomic differentials in health related behaviours and potentially, health outcomes in the UK.

Healthy dietary practices among rural and semi-urban Blacks in the Northern Province of South Africa

The aim of the study was to investigate five healthy dietary behaviours in a sample of rural and semi-urban South Africans. The sample consisted of 200 adults, 100 from an semi-urban area (Mankweng) and 100 from a rural area (Tiberius) in the central region of the Northern Province of South Africa. The two geographically different communities were chosen by convenience and the participants in the two communities were choosen by cluster sampling. Results indicate that about a third (30% in semi-urban and 34% in rural) of the study sample are overweight and 18% are obese. A moderately high prevalence of six simple healthy dietary practices was found. However, there was a very low prevalence rate of eating fruits daily among both semi-urban (10%) and rural dwellers (9%). Semi-urban dwellers showed significantly higher healthy diet behaviour than rural dwellers in regard to avoiding fat, trying to eat fiber, limiting red meat, and limiting salt. Men reported more than women that they tried to eat fiber and they had more often breakfast everyday. Being semi-urban and female were significantly associated with the healthy dietary index, whereas age, BMI, educational level and marital status were not. The results give insight into dietary health behaviour practices and the factors that influence them, which have practical implications for dietary health promotion.