Evaluation Of Nutrition Interventions Research Articles

Evaluation of Nutritional Interventions in Preventing Type 2 Diabetes Mellitus: A Randomized Controlled Trial

This study aimed to evaluate the effectiveness of the structured dietary intervention in reducing the risk of developing type 2 diabetes mellitus and improving associated metabolic health indicators. We included 530 participants randomly assigned to an intervention group with a Mediterranean-style diet and a control group with generic dietary guidelines. The incidence of type 2 diabetes mellitus was the primary outcome, whereas changes in fasting plasma glucose, lipid profiles, and body composition were the secondary outcomes. After 24 months, the incidence of type 2 diabetes mellitus was significantly lower among participants in the intervention group than those in the control group (P < 0.05). Fasting glucose, hemoglobin A1c, total cholesterol, and low-density lipoprotein levels were decreased (P < 0.05), and high-density lipoprotein levels were increased among participants in the intervention group than in those in the control group (P < 0.05). Also, body weight, blood pressure, and body mass index, major negative predictors of fasting glucose levels, were significantly decreased in participants in the intervention group than in those in the control group (P < 0.05), irrespective of other covariates. Dietary intervention substantially reduced the risk of developing type 2 diabetes mellitus and improved glycemic control, lipid profiles, and overall metabolic health.

Evaluation of Nutritional Interventions in the Care Plan for Cancer Patients: The NOA Project.

The NOA (Oncological Nutrition in Andalusia) project analyses the degree of integration and areas of improvement in implementing nutritional support in the care plans of cancer patients in Andalusia. The aim was to analyse nutritional interventions for better care of cancer patients and for the improvement of the management of malnutrition in cancer. A prospective evaluation of the implementation of two areas of improvement in nutrition was conducted in three hospitals. Data were collected from each hospital over a six-month period using an online platform. A standardised care plan was designed for hospitals in Andalusia, in which proposed improvements were devised and prioritised, selecting nutritional screening in oncology services and the participation of the Nutrition Support Team (NST) on the tumour boards, as well as the assessment of the patients presented at these sessions. Our results indicated an increase in the number of medical records with nutritional evaluation results six months later, regardless of the type of tumour or hospitalisation; and there was greater participation of the NST on the tumour boards, mainly for head and neck and oesophagogastric cases. Solutions for improvement have been pinpointed and implemented that have positively impacted the nutritional care plan in the course of oncological disease.

Evaluation of Nutrition Intervention On Snack's Eating Habits and Anthropometric Status of College Students in Malang City

Background: Problems that arise in students based on the results of the 2016 study indicate that more than 80% of students like to eat unhealthy snacks such as packaging snacks, fried foods, instant noodles, and meatballs. Where snacks contain high energy, carbohydrates, protein, saturated fat, and salt. The excess energy and nutrients intake are related to increasing the metabolic incidence of syndromes and the main risk factors for cardiovascular disease.Objectives: This study aims to determine the effectiveness of giving nutritional interventions to eating habits and anthropometric status of college students in Malang.Methods: The quasi-experimental design with 31 participants from college students in Malang. Nutrition interventions provided in the form of education related to healthy snacks and assistance in making healthy snacks. The instruments used were pretest-posttest, questionnaire, and semi FFQ. Data processing was carried out by descriptive statistical analysis and dependent t-test at a 95% confidence level.Results: There was a significant increase in knowledge related to healthy snacks for subyek penelitiants (p <0.01) indicated by the results of the pre-test and post-test. There was an increase in the influence with nutrition claims by 31% and there was a significant difference between before and after the intervention (p = 0.013). The results of a healthy semi FFQ snack for the fruit category experienced a significant increase after being given an intervention program (p <0.01), while the semi FFQ results for unhealthy snacks for the category of salted crackers, chocolate/candy, pudding, and market snacks tended to decrease in consumption although not significant. The prevalence of overweight and obese in participants before being given intervention was 29% and decreased after being given intervention to 22.6% even though there was no significant difference (p = 0.096).Conclusions: There is an increase in the influence of 'nutrition claims' and fruit consumption significantly. While the prevalence of obese tends to fall even though it is not significant between college students.

Validity of a modified food and nutrition literacy questionnaire in primary school children in Iran.

The present study aimed to assess the relative validity and reliability of a modified Food and Nutrition Literacy (M-FNLIT) questionnaire in primary school children in the city of Mashhad. The study was conducted in four phases. In the first step, the content and face validity of the questionnaire were evaluated by Delphi consensus as well as interviewing the students. Then, construct validity was examined using Confirmatory Factor Analysis (CFA). The internal consistency and reliability of the questionnaire were also assessed using Cronbach α and Intraclass Correlation Coefficient (ICC), respectively. Finally, a receiver operating characteristic analysis was performed to detect the cut-off scores of the M-FNLIT scale. Findings of two rounds of Delphi showed satisfactory levels of Content Validity Ratio: 0·72 and 0·92, Content Validity Index (CVI): 0·92 and 0·98, respectively. The results of CFA for domains and subscales of the M-FNLIT questionnaire including cognitive domain (understanding food and nutrition information and nutritional health knowledge) and skill domain (functional, food choice, interactive, and critical skills) indicated acceptable fit indices. M-FNLIT subscale-specific Cronbach α values ranged between 0·68 and 0·8 and ICC was 0·95 (95 % CI 0·93, 96). The final questionnaire included forty items (thirty-six Likert-type and four true-false items). FNLIT scores were categorized as low (≤ 58), medium (> 58–< 81), and high (≥ 81). The M-FNLIT questionnaire has a good level of validity and reliability to measure food and nutrition literacy in primary school children. The questionnaire can be applied in the evaluation of nutritional interventions in this age group.

Adjusting plasma or serum zinc concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

ABSTRACTBackgroundThe accurate estimation of zinc deficiency at the population level is important, as it guides the design, targeting, and evaluation of nutrition interventions. Plasma or serum zinc concentration (PZC) is recommended to estimate zinc nutritional status; however, concentrations may decrease in the presence of inflammation.ObjectivesWe aimed to assess the relation between PZC and inflammation in preschool children (PSC; 6–59 mo) and nonpregnant women of reproductive age (WRA; 15–49 y), and to compare different inflammation adjustment approaches, if adjustment is warranted.MethodsCross-sectional data from 13 nationally representative surveys (18,859 PSC, 22,695 WRA) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed. Correlation and decile analyses were conducted, and the following 3 adjustment methods were compared if a consistent negative association between PZC and C-reactive protein (CRP) or α-1-acid glycoprotein (AGP) was observed: 1) exclude individuals with CRP > 5 mg/L or AGP > 1 g/L; 2) apply arithmetic correction factors; and 3) use the BRINDA regression correction (RC) approach.ResultsIn 6 of 12 PSC surveys, the estimated prevalence of zinc deficiency increased with increasing CRP deciles, and to a lesser extent, with increasing AGP deciles. In WRA, the association of PZC with CRP and AGP was weak and inconsistent. In the 6 PSC surveys in which adjustment methods were compared, application of RC reduced the estimated prevalence of zinc deficiency by a median of 11 (range: 4–18) percentage points, compared with the unadjusted prevalence.ConclusionsRelations between PZC and inflammatory markers were inconsistent, suggesting that correlation and decile analyses should be conducted before applying any inflammation adjustments. In populations of PSC that exhibit a significant negative association between PZC and CRP or AGP, application of the RC approach is supported. At this time, there is insufficient evidence to warrant inflammation adjustment in WRA.

Chronic Undernutrition and Food Insecurity Among Children and Adolescent Girls in Myanmar (P04-052-19)

Abstract Objectives Myanmar has recently conducted the first ever comprehensive nation-wide Micronutrient and Food Consumption Survey to provide the update and reliable data required for planning, implementation, monitoring and evaluation of nutrition interventions. This abstract presents about data on anthropometric indicators and household food security. Methods The study was a nation-wide cross-sectional survey conducted from Nov 2017 to May 2018 in all 15 states/regions (SR) of Myanmar. Thirty clusters per SR (total 450 clusters) were selected by probability proportionate to size method. Simple random sampling was applied for selection of 60 households in each cluster, total 27,339 households were studied. Measurements of weight and height in 6–59 month children (n = 8959), 5–9 year children (n = 9000), 10–14 year (adolescent) girls (n = 919), reproductive age women (15–49 years) (n = 9027) and 15–49 year men (n = 9022) and household food security status were assessed. Results One third (33.2%) of households were suffering from food insecurity. Among children 6–59 months, 26.7% were stunted, 6.7% were wasted, 19.1% were underweight and 0.8% had overweight. In 5–9 year children, 22.1% were stunted, 14.6% had thinness and 3.3% had overweight; in adolescent girls, 24.2% were stunted, 18.8% had thinness and 5.5% had overweight. Higher rate of stunting rate was found in children and adolescent girls from food insecure households than those from food secure ones. Underweight was found in 14.3% and 19.7%; overweight in 22.9% and 11.4%; and obesity in 7.3% and 2% of women and men respectively. Conclusions Myanmar is facing both acute (&gt;5% wasting) and chronic undernutrition (&gt;20% stunting) as public health problems among preschool children. High burden of chronic undernutrition among these children may pose increased risk of overweight among adolescents and adult population. Although Myanmar is known as food secure at union level being an agricultural country, 1 in 3 households in the country is still food insecure and facing undernutrition from childhood to adolescent and adult. Coordinated efforts should be made to improve nutritional status of population such as improving agriculture and livestock sectors, promotion of essential health services including quality antenatal care, promotion of optimal infant and young child feeding and healthy dietary habits. Funding Sources Myanmar Ministry of Health and Sports, WHO, UNICEF and World Bank group funded this nationwide survey. Supporting Tables, Images and/or Graphs

Methodological challenges to evaluating the health economic impact of nutritional interventions

Enhancing the diet by increasing or decreasing consumption of selected foods or nutrients is a well-accepted method of improving population health in certain settings. However, the economic impact of most dietary interventions is largely unknown. Studies in the past decade have started to estimate the effects on healthcare costs, often through economic models, but the evaluation of nutritional interventions is challenging and faces uncertainties unique to the domain, compared with more straightforward analyses of medical or surgical interventions. This paper discusses three main areas of uncertainty: measurement of consumption, assessing effectiveness, and considerations about the economic inputs to a model. Insight into these sources of uncertainty can help readers assess the quality of existing studies, and provide guidance for their future research.

Capturing Changes in HIV-Infected Breastfeeding Mothers’ Cognitive Processes from Before Delivery to 5 Months Postpartum: An Application of the Pile-Sorting Technique in Haiti

BackgroundThe cognitive processes involved in individuals’ perceptions and prioritization of information, and how these change with experience or exposure to interventions, are rarely examined in the evaluation of nutrition interventions. Exclusive breastfeeding counseling is a common infant and young-child feeding intervention and is used to promote HIV-free survival in the prevention of mother-to-child transmission programs. However, it is often designed without adequate attention to the changes in mothers’ perceptions over the course of their early breastfeeding experiences. ObjectiveThe aim of this study was to identify HIV-infected breastfeeding mothers’ cognitive structure (their organization of messages and ideas) of infant feeding messages and to characterize whether their cognitive organization of infant feeding messages changed from pregnancy through the first 5 mo postpartum. MethodsWith the use of semistructured interviews and the cognitive mapping technique of pile sorting, we interviewed 30 HIV-infected breastfeeding mothers in Port-au-Prince, Haiti. We asked them to sort and rate 18 infant feeding messages 3 times (during pregnancy, 0- to 1-mo postpartum, and 3- to 5-mo postpartum). We analyzed their responses by using multidimensional scaling, property fitting, and partition analyses. ResultsAt all 3 visits, we found consistency in women’s cognitive mapping of messages. For example, mothers consistently differentiated messages pertinent for exclusive breastfeeding compared with those that pertained to other practices. However, subtle variations in mothers’ cognition over time were also evident, particularly at 0- to 1-mo postpartum, when message proximity was tightly clustered compared with the earlier and later periods. ConclusionsWe conclude that mothers share a common cognitive organization of infant feeding messages and that this organization changes over time. Attention to variations in cognition can support context-sensitive, patient-centered counseling by practitioners and improve the effectiveness of nutrition interventions. Pile sorting is an efficient, systematic technique to examine cognitive processes related to health and nutrition.

An evaluation of nutrition intervention during radiation therapy in patients with locoregionally advanced nasopharyngeal carcinoma.

PurposeTo evaluate the effectiveness of nutrition intervention during radiation for patients with locoregionally advanced (III-IVa) nasopharyngeal carcinoma (NPC).Materials and MethodsWe retrospectively reviewed 117 patients with locoregionally advanced (III-IVa) NPC treated between December 2015 and March 2016 in Zhejiang Cancer Hospital. All the patients underwent radical chemo-radiotherapy. First, all the patients were divided into the nutrition intervention group and the control group, depending on whether they accepted nutrition intervention. Repeated measures were used to analyze the change of nutritional indicators before, during, and after radiation therapy and to simultaneously compare the difference in nutritional status between the two groups at the same time point. Subsequently, the 117 patients were divided into the malnourished group (weight loss > 5%) and the non-malnourished group (weight loss ≤ 5%) according to whether their weight loss was over 5% of their body weight during radiotherapy. Chi-square tests and logistic regression analysis were used to explore the influence factors for the weight loss.ResultsThe repeated measures showed that all indicators including weight, body mass index (BMI), albumin, pre-albumin(PA), and prognostic nutritional index (PNI) dramatically declined in both groups compared with their levels before radiation therapy (All p < 0.001). However, there was no significant difference between the intervention and non-intervention groups regarding the mean values of nutritional indicators at the same time point, that before, during, and after radiation therapy, except BMI (All p > 0.05). Logistic regression analysis revealed grade ≥ 3 radiation-induced oral mucositis as the prognostic factor for a poor nutrition status (odds ratio, OR = 3.232, p = 0.021, confidence interval, CI [1.198, 8.820]). Besides this, patients with a decrease of >15% in pre-albumin level were more likely to be malnourished (OR = 2.442, p = 0.041, CI [1.036, 5.757]). Similar to that observed in our former analysis, we did not find that existing nutrition intervention can significantly improve nutritional status (OR = 1.217, p = 0.704, CI [0.042, 3.348]).ConclusionsOur study shows that the nutritional status of the patients gradually declined during treatment. We concluded that grade ≥ 3 radiation-induced oral mucositis would aggravate the extent of malnutrition during radiation therapy in patients with locoregionally advanced NPC. Pre-albumin level was a predictive marker for weight loss in patients with NPC. However, current nutrition intervention during radiation therapy can't significantly reverse nutritional status.

Validation of General Nutrition Knowledge Questionnaire for Adults in Uganda

Knowledge is a significant component of several behavioral theories used in nutrition, including the health belief and stages of change models. In Uganda, the evaluation of nutrition interventions is limited by the lack of validated tools, especially of nutrition knowledge. The objective in this study was to validate (i.e. construct validity and reliability) a general nutrition knowledge questionnaire (GNKQ) for adults in Uganda.A revised version (i.e. after expert review and face validation) of the GNKQ comprised 47 questions grouped in five domains assessing knowledge on recommendations (4), food groups (17), food choices (10), nutrition and disease relationship (11), and food fortification (5). A purposive sample of teachers (n=40) from Kampala and students (n=77) from Makerere University was recruited to complete the GNKQ twice, at least within one week apart. Students completed the questionnaire using the Qualtrics online platform; while the head teachers completed the GNKQ by hand. Item difficulty (acceptable range: 0.1–0.9) and discrimination analyses (acceptable above 0.2) were applied to data to remove simple and complex items, and those that failed to predict scores within each of knowledge domains. After removing the items, the questionnaire remained with a total of 28 questions with 89 items. Before deletion of any items, we assessed the internal consistency (Cronbach α), the content validity (Student t‐test) and test‐retest reliability for all subjects and each sub‐population group. The overall Cronbach alpha (all groups) was 0.93 and 0.94 at the first and second round, respectively. This was 0.84 and 0.85 for the head teachers and 0.94 and 0.95 for the students, at the first and second round, respectively. Overall internal consistencies for the following domains were considered acceptable (i.e. 0.70–0.95), food groups (0.81 and 0.81), nutrition and disease relationship (0.78 and 0.84), and food fortification (0.94 and 0.94) in the first and second rounds, respectively. For nutrition recommendations and food choices the internal consistencies were below 0.7. The overall test‐retest reliability using Pearson correlation was 0.89. The Pearson correlation coefficients were 0.93 and 0.63 for students and head teachers, respectively. The overall nutrition knowledge scores of nutrition students (104.8), engineering students (71.8) and head teachers (76.2) were significantly different (P&lt;0.05). Trends and differences in knowledge scores remained similar after the second round of the questionnaire, 106.7, 72.0, and 79.7, respectively. Overall findings showed that the GNKQ is valid and reliable to evaluate nutrition knowledge among adults in Uganda. Low internal consistencies for some dimensions require continuous review of specific items. Further studies will address test‐retest reliability of the GNKQ using a larger population sample.Support or Funding InformationUSAID Borlaug Higher Education for Agricultural Research and Development (BHEARD) Program fellowship. Margin of Excellence funds from the Division of Nutritional Sciences at the University of Illinois Urbana‐Champaign (UIUC). UIUC Graduate College's Focal Point ‐UCOUNT project.

Development of Korean Healthy Eating Index for adults using the Korea National Health and Nutrition Examination Survey data

Purpose: The current study was conducted in order to develop the Korean Healthy Eating Index (KHEI) for assessing adherence to national dietary guidelines and comprehensive diet quality of healthy Korean adults using the 5th Korea National Health and Nutrition Examination Survey (KNHANES) data. Methods: The candidate components of KHEI were selected based on literature reviews, dietary guidelines for Korean adults, 2010 Dietary Reference Intakes for Koreans (2010 KDRI), and objectives of HP 2020. The associations between candidate components and risk of obesity, abdominal obesity, and metabolic syndrome were assessed using the 5th KNHANES data. The expert review process was also performed. Results: Diets that meet the food group recommendations per each energy level receive maximum scores for the 9 adequacy components of the index. Scores for amounts between zero and the standard are prorated linearly. For the three moderation components among the total of five, population probability densities were examined when setting the standards for minimum and maximum scores. Maximum scores for the total of 14 components are 100 points and each component has maximum scores of 5 (fruit intakes excluding juice, fruit intake including juice, vegetable intakes excluding Kimchi and pickles, vegetable intake including Kimchi or pickles, ratio of white meat to read meat, whole grains intake, refined grains intake, and percentages of energy intake from carbohydrate) or 10 points (protein foods intake, milk and dairy food intake, having breakfast, sodium intake, percentages of energy intake from empty calorie foods, and percentages of energy intake from fat). The KHEI is a measure of diet quality as specified by the key diet recommendations of the dietary guidelines and 2010 KDRIs. Conclusion: The KHEI will be used as a tool for monitoring diet quality of the Korean population and subpopulations, evaluation of nutrition interventions and research.

Agreement Between a Food Frequency Questionnaire and the Willett Questionnaire in Overweight or Obese Pregnant Women

Background &amp; Aims: Overweight and obesity during pregnancy is associated with an increased risk of many adverse health outcomes for both women and their infants. There is a need for simple food frequency questionnaires to assess nutritional intake and aid implementation and evaluation of nutritional interventions in these women. The aim of this study was to compare a newly developed food frequency questionnaire with the Willett food frequency questionnaire in Australian pregnant women who were overweight or obese. Methods: 170 overweight or obese pregnant women (12-20 weeks’ gestation) completed both the Willett and the devised (LIMIT) food frequency questionnaire with n=41 excluded due to unrealistic energy intake or incomplete questionnaires. The mean nutrient intake for each questionnaire and the mean difference in nutrient intake between the questionnaires was assessed. The correlation and agreement between the two questionnaires were assessed by Spearmans correlation coefficients and Bland-Altman method. Results: There were high correlations for total energy intake, protein, carbohydrates, cholesterol, iron, folate, and caffeine (r&gt;0.50, P&lt;0.01), and moderate correlations for fat, fibre, and calcium (r=0.4-0.5, P&lt;0.01). Correlations were low (r&lt;0.3) for vitamins. There was no significant systematic error between the two food frequency questionnaires with the exception of alcohol, calcium, iron, and folate (P&gt;0.05). The limit of agreement (LOA) was wide (LOA &lt;50% or &gt;200%) for macronutrients, calcium, and folate, but within the acceptable range for iron, vitamins, and caffeine (LOA 133%). Conclusions: There is good agreement between the Willett and the LIMIT food frequency questionnaires in estimating macronutrient and some key pregnancy-related micronutrients for group-level comparisons.

Measurement of Food Consumption to Inform Food Fortification and Other Nutrition Programs: An Introduction to Methods and Their Application

Information on dietary intake is essential for the assessment, planning, monitoring, and evaluation of nutritional interventions. A number of methods are available, each with unique strengths and weaknesses. Dietary intake records, 24-hour recalls, and Food Frequency Questionnaires (FFQs) determine food consumption and nutrient intakes of populations based on individual assessment; few countries have such data at national or regional levels. Food and Agriculture Organization (FAO) Food Balance Sheets (FBS) and food industry data, available in most countries, permit calculations of per capita food consumption but do not provide data on individual consumption. Household Consumption and Expenditures Surveys (HCES) are available for most countries and provide data that can be used to calculate consumption of fortification vehicles and to estimate additional intakes of micronutrients delivered through them to specific population groups. To introduce the reader to the set of papers included in this Supplement reviewing methods and experience with HCES to inform nutrition, and specifically food fortification programs. The Monitoring, Assessment, and Data (MAD) working group and colleagues critically reviewed experiences in estimating dietary intakes,focusing on the use of secondary analysis of HCES. HCES predict coverage of the population that consumes a fortification vehicle and consumed amounts of fortification vehicles. HCES allow comparisons of different population strata and may also approximate micronutrient adequacy, based on nutrient density, at the household level. HCES are useful to inform food fortification and other nutrition programs for planning interventions, but further work is necessary. Currently, combined use of traditional dietary surveys is needed for assessment and for program monitoring and evaluation.

Diets of minority ethnic groups in the UK: influence on chronic disease risk and implications for prevention

Summary Introduction 1Definitions of ethnic groups and demographics of minority ethnic groups in the UK ○ 1.1 Definitions of ‘ethnic groups’ and ‘ethnicity’ ○ 1.2 Demographics and characteristics of minority ethnic groups in the UK – Countries of origin – Age/sex distribution and life expectancy – Geographical distribution and size of household – Religious beliefs – Education and employment patterns Key points 2Overview of the health profile and dietary habits of minority ethnic groups in the UK ○ 2.1 Available surveys ○ 2.2 Overview of the health profiles among adults from minority ethnic groups – Overall health – Cardiovascular disease (CVD) – Coronary heart disease (CHD) – Stroke – Type 2 diabetes – Obesity ○ 2.3 Possible causes of increased disease risk among minority ethnic groups ○ 2.4 Smoking, drinking and physical activity habits ○ 2.5 Dietary habits and nutritional status ○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups – Overall health – Diet and health behaviour patterns ○ 2.7 Gaps in data availability Key points 3Factors affecting food choice – Income and socio-economic status – Food availability and access – Awareness of healthy eating – Religious beliefs – Food beliefs – Time and cooking skills – Generation and gender Key points 4Traditional diets of minority ethnic groups ○ 4.1 Overview of traditional diets of minority ethic groups – South Asians – African-Caribbeans – Chinese ○ 4.2 Dietary acculturation ○ 4.3 Nutritional composition of ethnic-style cuisine Key points 5Nutritional interventions and health promotion among minority ethnic groups ○ 5.1 Effective nutritional interventions ○ 5.2 Health promotion interventions to prevent problems associated with fasting ○ 5.3 Priorities for nutritional interventions and health promotion ○ 5.4 Using behaviour change models ○ 5.5 Current community initiatives ○ 5.6 Catering for institutionalised individuals ○ 5.7 Recommendations for future research, policy and practice Key points 6Conclusion • Acknowledgements • References Summary According to the latest census, non-white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African-Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well-designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non-white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups.

Evidence-based evaluation of nutritional interventions: a comprehensive review and critical appraisal of current methods

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Nutrition among Older Adults in Africa: the Situation at the Beginning of the Millenium

Most Africans enter old age after a lifetime of poverty and deprivation, poor access to health care and a diet that is usually inadequate in quantity and quality. However, nutrition interventions in African countries are directed primarily toward infants and young children, as well as pregnant and lactating women. This situational analysis focuses on two key areas to identify priorities for future research and policy development: the nutritional status of older Africans and determinants of undernutrition. Based on the scant evidence available, the prevalence of undernutrition is high in older African men (9.5-36.1%) and women (13.1-27%); however, in some urban areas there is evidence that older adults are experiencing the nutrition transition. Information on micronutrient status is sparse, yet it appears that anemia related to suboptimal folate status is a particular problem. Important determinants of poor nutritional status in the elderly in the African context include inadequate household food security, war and famine, and the indirect impact of HIV infection and AIDS. The rapidly increasing size of the older population, combined with their increased burden of care-giving responsibilities and severe socioeconomic hardship, indicates an urgent need for increased attention to this group, including applied research on nutrition problems and the development and evaluation of nutrition interventions.

Evaluation of nutrition interventions: methodologic considerations

In most nutrition intervention studies it is not nutritional status but 1 or more specific aspects of nutrition that are measured and the difficulty of measurement has increased with the complexity of the intervention models. The direct intervention model such as the iodization of salt includes the provision of a nutrient supplement to control a specific nutritional deficiency disease with the end effect easy to measure. The essence of this model is that confounding variables are randomly assigned to the experimental and control groups; they are not eliminated or measured but are balanced. 2 problems arise in applying this model in the community: 1) violation of the random assignment rule and 2) meeting design requirements may force a change in the questions being asked. In a multi-stage model there are some elements that increase the complexity of the study: 1) the expected end effect has less specificity 2) the influence of the intervention may be conditioned to a degree by other variables and 3) the hypothesis linking the intervention to the expected outcome has a less severe foundation. The design of this model has moved from simple direct intervention to one of epidemiology. Pathway analysis of intervention programs may help to explain negative evaluations and lead to program improvement. The multi-effect model considers the many pathways which program effects might take; the author argues that linear thinking may result in negative assumptions about program effects. As interventions have changed methodological demands have done the same. There is now a need to measure both intervening and confounding variables as well as outcome variables a recognition that researchers should be looking toward functional measures as outcome variables and that analytic approaches used in more elaborate designs call for data analysis of the individual rather than at the group level. Other methodological considerations include definition of goals identification of the control group duration of observation field staff data handling and statistical advice. The most crucial element in this area is establishing proper goals at the onset of the study.