Family Diet Research Articles

Changes in the pattern of cultivated species and loss of sustainability in central Veracruz, Mexico

The economic, social, and technological conditions in agriculture have changed due to public policies implemented by the Mexican government. These changes have forced producers to make decisions to adapt to a complex agricultural reality. The objective of this research is to analyze the changes in cropping patterns over four decades and their impact on sustainability in a local context. A survey and in-depth interviews were conducted among producers in agricultural and rainfed areas in central Veracruz, Mexico. The findings suggest that the promotion and subsequent reduction of public spending in favor of agricul-tural production resulted in the gradual introduction and exclusion of crops, as well as the fundamental management practices underlying them, such as fertilization, weed, disease, and pest control. This led to a loss of sustainability as it promoted monoculture, the use of agrochemicals, and the commercialization of crops. This not only simplified the crop pattern but also affected the family's diet, created conditions for increased pest and disease presence, and degraded soil life and agrobiodiversity, including medicinal and foodplants subject to harvesting. These findings should be taken into account when defining medium and long-term strategies.

Improving dietary diversity among women of reproductive age group (15-49 years) through community-based activities across four districts of India

Background: Globally, more than two billion people have micronutrient deficiencies (MiNDs), with approximately half of them residing in India. Nutri-gardens offer the opportunity to diversify a family's diet. The objective of the present study is to assess the effectiveness of growing nutri-gardens in improving the dietary diversity of women and girls compared to no nutri-gardens. Methods: It was a post-test-only comparison with a control group. The intervention and control groups were similar in all aspects except that the intervention group received seeds for growing a nutri-garden. A random sample of 100 adolescent girls (15-19 years) and women per district in the intervention and control groups was drawn from four districts. A campaign was launched to spread awareness of nutri-gardens, a balanced diet, and food groups. The data were collected using a pre-designed semi-structured questionnaire that included a standardized diet quality questionnaire. Results: In total, there were 804 women and adolescent girls. Out of 804, 457 grew (the intervention group) and 347 did not grow nutri-garden (the control group). Women and girls who grew nutri-gardens had 0.38 times higher odds of having higher dietary diversity (≥5) than women and girls who did not. Similarly, women and girls who are educated have higher odds of having a higher dietary diversity compared to illiterates. Conclusions: The study concludes that establishing nutri-garden along with nutrition education improved dietary diversity among girls and women in the intervention areas. Nutri-garden is a low-cost sustainable approach to providing fruits and vegetables daily and meeting their daily requirements.

The Relationship Of Mother's Knowledge of Nutritional Information and Attitude Through Social Media with Family Food Patterns at Posyandu Mawar

Introduction: Knowledge is the result of knowing which is a concept in a person's mind as a result of someone sensing a certain object. Nutritional knowledge is the main problem that occurs in society regarding various nutritional problems that occur in Indonesia. Indirectly, the mother's knowledge will influence the nutritional status of her family. Knowledge influences the mother in providing food for her family, the better the mother's knowledge, the better the family's diet, because the mother is the originator of the family food, from the one who prepares it, chooses the menu for the family. Research Objective: The aim of this research is to determine the relationship between knowledge of nutritional information and maternal attitudes via social media towards family food patterns at Diposyandu Mawar. Method: used in this research is analytical descriptive with a cross sectional approach using interview and questionnaire methods. Conclusion: The conclusion of this research is that there is a relationship between knowledge and attitudes towards family eating patterns. because the mother determines the food supply in the family which can determine the nutritional status of the family.

A Comparative Study of Household Women in Delhi NCR on Consumer Perception Towards Milk and Milk Products

Milk and its derivatives are a necessary component of a family's diet. It is precisely this kind of food that offers the critical nourishment required for people to be healthy. Milk is also a source of revenue for cattle ranchers. Consumer perception is essentially the consumer's behavioral habit while acquiring products or services (Jisana, 2014). Companies pay close attention to their consumers' requirements and requests to please them and benefit from increased sales. Every company's marketing department is focused on developing methods for expanding their customer base via effective advertising and promotion of their goods. However, customers prefer to patronize independent milk vendors, particularly those not branded, when selling milk and milk products. They decide to buy milk based on their reflection, regardless of whether they can obtain the highest quality goods. This research aims to decipher consumer behavior toward milk and related products, particularly in Delhi and from the perspective of women homemakers. A study of 103 households in the Delhi NCR was conducted to ascertain their preferences for milk and milk products based on the brand of the product. The research shows a considerable variation in consumers' preferences for branded and unbranded milk and milk products.

Dietary intake in children on the autism spectrum is altered and linked to differences in autistic traits and sensory processing styles.

Diets of children and adolescents on the autism spectrum often differ when compared to their non-autistic peers. Most dietary studies have been limited by small sample sizes and rarely assess the heterogeneity of autism. Addressing this gap, this study compared the anthropometrics, dietary composition, dietary quality, and food variety of 154 Australian children and adolescents on the spectrum and 213 non-autistic children (71 siblings and 142 unrelated controls). Beyond the case-control approach, within-group comparisons assessed the influence of autism clinical presentations and sensory processing styles on body mass index (BMI) and measures of dietary intake among those on the spectrum. In this word first study of diet that included between-group comparisons with non-autistic peers (siblings and an unrelated comparison group) and within-autism group comparisons, we found that children on the spectrum consumed limited variety and lower quality of food and non-autistic siblings also ate comparably higher levels of energy-dense, nutrient poor food, and less diary. This may be due to autistic traits influencing family's diets or shared sensory sensitivities driving dietary intake. Within the autism group, higher autistic traits were associated with lower BMIs and a specific dietary pattern higher in simple carbohydrates and lower in unprocessed protein. Contrastingly, greater sensitivity to sensory stimuli was associated with a healthier diet. Increased age was linked to more varied diets but also diets higher in saturated fats and energy-dense, nutrient poor foods. Overall, this research highlights that potential mediators of dietary intake, such as familial influences, autistic traits, sensory processing styles, age and sex, need to be considered when assessing diet in the autistic population. LAY SUMMARY: In this study of dietary differences linked to autism, children, and teenagers on the spectrum ate fewer different foods and were less likely to eat recommended amounts of fruits and vegetables when compared to non-autistic siblings and unrelated children and teenagers. There were also family differences, in that those on the spectrum and their siblings ate more unhealthy foods and less dairy. Among those on the spectrum, dietary differences were linked to age, sex, autistic traits and sensory processing styles.

A Mixed-Methods Examination of the Impact of the Partnerships to Improve Community Health Produce Prescription Initiative in Northeastern North Carolina.

To conduct a mixed-methods examination of the impact of the Partnerships to Improve Community Health produce prescription initiative in northeastern North Carolina. Quantitative surveys were conducted among participants before and after the distribution of produce prescription vouchers. Univariate statistics were used to describe the participant population, and paired t tests were used to examine change in fruit and vegetable intake. Qualitative, in-depth telephone interviews were conducted among participants, health educators, and food retailers and coded for themes. Eight health promotion programs, 2 food pantries, and 11 food retailers. In each health promotion program or food pantry, between 6 and 97 participants were enrolled. Produce prescription vouchers were distributed to participants and redeemed at local food retailers. An increase in local fruit and vegetable purchasing and consumption. Of the produce prescription participants who completed the baseline survey (n = 93), 86% were female, 64% were African American, and 68% were food insecure. The voucher redemption rate was 18%. The majority of participants indicated that they visit farmers' markets more now than before the produce prescription initiative, that shopping at the farmers' market made it easy to include more fresh produce in their family's diet, and that they tried a new farmers' market because of the produce prescription initiative. All health educators and food retailers who participated felt that the initiative benefited their program or operation and were willing to partner with the program again. While redemption rates were lower than anticipated, the produce prescription initiative had positive impacts on participants' local fruit and vegetable purchasing and consumption. Because of COVID-19, the initiative was not implemented until late in the North Carolina produce season. Moving forward, the program will start earlier and work with local food retailers to connect with their communities to increase redemption rates.

Opinion of family farmers on organic food supply to the Brazilian National School Feeding Program - a case study

Objective: To investigate the opinion of family farmers about the supply of organic food to the National School Feeding Program (PNAE) in the state of Paraná, Brazil. Method: The convenience sample consisted of 44 family farmers from nine cooperatives and associations located in eight different mesoregions of the state of Paraná that supplied organic food to the PNAE. An online survey was conducted to evaluate the farmers' opinion on possible changes in the cooperatives' revenue and organization; diversification and production increase; difficulties in commercialization; increase in income, and improvement in food consumption after supplying to the PNAE. Results: According to the farmers’ opinion, there was better organization (100%) and an increase in the cooperatives' revenue and production (86.36%), after supplying to the PNAE. 75% of the farmers diversified their crops and 52.3% reported an increase of up to 25% in their family income. In addition, it was reported a better acceptance of the school feeding, diversification in the family's diet, improved self-esteem, closeness between producers and consumers, and the return of family members to the rural property. Conclusion: In the opinion of family farmers, PNAE has been fulfilling its role as a promoter of Food and Nutritional Security in the development of healthy habits, besides contributing to the increase in family income and promoting local sustainable development, following the World Health Organization's agenda.

Perspectives on sugar consumption expressed on social media by French-speaking and Danish-speaking parents.

Meanings and practices attributed to sugar emerged as important barriers to healthy eating in an earlier study with French and Danish parents. Considering the impact of excessive sugar intake on human health and childhood obesity, this study focuses on gaining further understanding of connotations, perceptions and attitudes related to sugar among parents. A thematic analysis of sugar-related posts and comments on blogs and Facebook pages was performed, and in-depth interviews with experts (one in each country) were conducted. Data were set in a Social Judgment Theory analytical framework. Sugar consumption appears as a two-sided experience, being at times dangerous, sinful and addictive, but also comforting and delightful. This "sugar dilemma" unfolded aspects between asceticism and hedonism, state governance and personal responsibility. Three main behavioral strategies on how parents deal with these ambivalences emerged: i) restriction, ii) moderation, and iii) liberation. Restriction was more noticeable in France, whereas liberation was more pronounced in Denmark. In both countries, the ones who defended the respective opposite positions (restriction or liberation) were targets of judgmental moral tones. The three behavioral strategies corresponded to the main attitudes demonstrated in reaction to anti-sugar messages, which align to the Social Judgment Theory constructs: acceptance, non-commitment and rejection. Findings shed light on dietary, behavioral and social challenges faced by parents and highlight the importance of a diversified approach to tackle sugar consumption among families - an approach that considers individuals' attitudes, social context and value systems. Furthermore, online sugar-related content yields valuable information on the social construction and morality of health and nutrition discourses and the misleading, confusing and overwhelming nature of social media content. Parents' discussions are an example of the general dilemmas between (gendered) parenting expectations, individual freedom and morality of food choices.

Ethnography of the bread shovel: from the Asturian house to the duality of tangible-intangible heritage

The Asturian rural house was a unit of production, consumption and reproduction. In this complex framework, bread (wheat, spelled and rye) was the basis of the family's diet. The cycle of bread, from the soil to the table, was present on all house aspects: the economic, the social and the symbolic and ritual. Within this field, despite its apparent simplicity, the so-called bread shovel stood out because it came into direct contact with the bread and it was loaded with multiple meanings, depending on who and when it was used. The ethnographic analysis of this object serves as a model to deal with the issue of the tangible-intangible heritage duality that characterizes ethnographic heritage today.

Children-and-Partner’s Food Preferences and Role of Woman as Caregiver: Key Elements of Food Choice Linked to Social Environment in a Consumer Population of Hermosillo City

Abstract Objectives The main objective was to identify determinants of food choice linked to the community food environment in a marginalized consumer population in the city of Hermosillo, Mexico. The specific objectives were to develop group interviews with women and to frame the data analysis within the field of research in food and nutrition security. Methods In this qualitative study design, we employed the focus group technique to ask participants “How do you decide which foods to obtain for your family's diet?”. To investigate further we asked, “What are those reasons that explain the selection of those foods?” Women who regularly attended a community center localized in a neighborhood with a very high grade of urban marginalization participated in the focus groups. Interviews were transcribed verbatim and three distinct methods were used to perform analysis: (1) content analysis (2) data organization, using software QSR NVivo, in relation to five dimensions of food and nutrition security: affordability, accessibility, acceptability, food quality, and care; and (3) triangulation between five co-authors (A.C.N., P.B.C., A.D.C.P., G.E.P.A., and M.I.O.V.). Results From May to November of 2019, four focus groups were conducted by a single facilitator in two community centers of Hermosillo (n = 27 participants). Reasons that explained the participant's food choices within the community food environment and that showed the highest number of mentions in the interviews were identified in relation to acceptability factors: children's food preferences, partner's food preferences, all household-members’ food preferences. The following extract reflects the main study findings: “When I can't do a certain thing it is because it's very expensive, but if there is a way, even if it's a little… for example, my middle-aged son really likes peppers and he eats them alone. So, I know that when I go to the store, I have to bring at least one, for him to eat other things.” Conclusions The study of food choice in this group of women denotes that their role as caregiver of food and nutrition in relation to their children-and-partner's food preferences are key elements of food decision-making processes, preceding the socioeconomic factors and constraints, they certainly face. Funding Sources Institutional small grant C.I.A.D., A.C.

P102 - The Effects of a Fruit and Vegetable Prescription Program (FVRx)® for Low-Income Individuals on Fruit and Vegetable Intake and Food Purchasing Practices

Background (Background, Rationale, Prior Research, and/or Theory): The FVRx® program subsidizes fruit and vegetable purchases for low-income individuals to reduce the burden of diet-related chronic conditions and food insecurity. Despite the growth of these programs, limited evidence is available on the impact of a produce prescription combined with nutrition education. Objective: To examine the effects of an FVRx® program providing both free fresh produce and nutrition education for SNAP-eligible adults. Study Design, Setting, Participants, Intervention: A six-month non-randomized control trial of an FVRx® program was pilot tested with 39 SNAP-eligible adults with diet-related chronic conditions using a unique university-community partnership in Athens, GA (mean age: 47.4 ± 11.6, 82.1% female, 20.5% Hispanic). Both FVRx (n = 22) and control (n = 17) groups were recruited through purposive sampling by the collaborating safety-net clinic and Hispanic community partner. The FVRx® intervention (June—December 2017) included a weekly produce prescription redeemable at one farmers market, a monthly SNAP-Ed nutrition education class based on DASH diet principles and food resource management, and a monthly health screening. Outcome Measures and Analysis: Self-administered surveys were used to assess dietary intake, nutrition knowledge, attitude, and food purchasing practices. Descriptive analysis and non-parametric tests were conducted. Results: After the intervention, the FVRx® group reported significantly higher intake of total fruit and vegetable servings, increased knowledge of fresh fruit and vegetable preparation, and the importance of fruits and vegetables in their family's diet (all P < .05). Most of the FVRx® group also reported switching the majority of their fruit and vegetable purchases from grocery stores to the farmers market, as well as increasing the amount of fresh vegetables purchased (all P < .05). Conclusions and Implications: Participation in an FVRx® program combining free fresh produce and nutrition education improves the knowledge, attitude, and consumption of fruits and vegetables and increases access to the local food system. Further research is needed to examine the role and design of nutrition education to maximize the impact of the FVRx® program. Funding: Supplemental Nutrition Assistance Program—Education, Wholesome Wave Georgia.

Food Guide Pagoda and the food safety of women: one-year follow-up study on the effects of the 2008 Sichuan Earthquake.

Women are a dominant force in the family's diet and nutrition in China. The shortterm effects of the 2008 Sichuan Earthquake were found. However, the long-term effects of the 2008 Sichuan Earthquake on the food safety, energy, and intake frequency of women remain unclear. This study analyzed the effects of the 2008 Sichuan Earthquake on the dietary behaviors of women one year after the earthquake. In this cross-sectional study, a total of 207 women were selected using the proportional sampling method. Among them, 91 were from the earthquake-affected area and 116 were from the non-affected area. Women from the earthquake-affected area paid significantly more attention to health, diet, food and water safety after the earthquake (p<0.05 for each category) when compared with those from the non-affected area. Women from the earthquake-affected area also had a significantly higher proportion of adequate understanding of low-energy food, properly separated their raw food from cooked food, ate high-energy food, and picky eating habits (p<0.05 for each category) than those from the non-affected area. In addition, women from the earthquake-affected area were more likely to adhere to the 2007 Chinese Food Guide Pagoda (FGP) guidelines for eating rice than those from the non-affected area (OR=2.25, 95% CI [1.13, 4.51]). The female survivors of the 2008 Sichuan Earthquake preferred high-energy food, paid more attention to food safety, and were more likely to adhere to FGP when compared to those that did not undergo the same tragedy.

Eating practices and habitus in mothers. A Brazilian population-based survey

A population-based cross-sectional study was conducted with mothers living in the city of Santos, Brazil, in order to investigate their eating practices, and the interface between those practices and the concept of habitus. From a cluster analysis of the scores for dietary pattern and for food preparation and consumption, the mothers were categorised into five clusters of eating practices: practical mothers (19.8%), symbiotic mothers (3.2%), health-conscious hedonists (17.3%), traditionalists (34.6%), and family cooks (25.1%). To access the habitus of the eating-practice clusters, the following variables were compared: location of residence, profession, socioeconomic status, weight-loss practices, risk behaviours for eating disorders, disordered eating attitudes, body dissatisfaction, and cultural and technological consumption. For all the groups, the observed eating practices were permeated by responsibility for the family's diet, but with different manifestations. For symbiotic mothers, practical mothers, and family cooks, the primary function of their relation with food was to nourish their families, with little expression of their own tastes and preferences. The traditionalists and the health-conscious hedonists, on the other hand, manifested their role as mothers by providing food considered ‘nutritionally proper’ to their family members. Furthermore, aspects of contemporary lifestyles, such as little time for food, individualisation of meals, and consumption of processed foods, were found to coexist with the valorisation and maintenance of the traditional meals within some groups. The variety of eating practices could not be understood as a linear association between economic and cultural capitals; however, eating practices seemed to interact with those capitals, composing a habitus.

Micronutrient deficiencies, beliefs about food and attitudes towards supplementation in women of reproductive age in rural Ghanaian communities

Micronutrient deficiencies in women of reproductive age are associated with multiple adverse outcomes for both mother and infant. Recent estimates indicate that globally over two billion people are at risk for vitamin A, iodine, and iron deficiency. In Ghana, only 4% of a family's diet comes from animal sources while 72% of their dietary energy supply is obtained from carbohydrates.METHODSA convenience sample of 169 women of childbearing age (15–49) in rural villages near Kumasi, Ghana were surveyed.RESULTSWomen stated they receive free prenatal vitamins only during pregnancy—not during lactation or between pregnancies. Data suggests many food groups were underrepresented in their diets, particularly those foods from animal sources. Findings indicate that women of childbearing age are experiencing micronutrient deficiencies. The recommended daily intake of Vitamin A is 800 mcg; women surveyed received 346.1mcg. Women who are pregnant and lactating as well as those who are not are deficient in zinc; however women who were not pregnant and lactating were more deficient (p= .0242).CONCLUSIONResults from this study demonstrate that women of childbearing age may benefit from nutrition education along with micronutrient supplementation during pregnancy, lactation, and between pregnancies.

Factory Workers in the Hills of West Virginia: The Values and Politics of Rural Industrial Workers in Hancock County, 1930–1965

When he was a young man in the 1950s and 1960s, Walter Danna used to hunt to supplement his family's diet. He fondly remembered hunting groundhogs, but he cautioned that you had to wait a couple of weeks after they were done hibernating before you bagged them or else they had a “mud taste.” Let them eat some grass and work that out of their system, he said. Danna was not a frontiersman, living in some remote, undeveloped wilderness. He spent his whole career as a steelworker in Hancock County, West Virginia. Yet his experiences and his lifestyle were quite different from industrial workers living in major cities. Steel and pottery workers in the rural environment of Hancock County adapted rural habits to the dictates of modern industrial capitalism. As a result, their values and their politics diverged from those of the more metropolitan segment of the American working class.

Poultry production profile and expected future projection in Bangladesh

The aim of this paper is to review the current status of poultry production and its future prospects in Bangladesh, covering both rural and commercial poultry production. As an important sub-sector of livestock production, the poultry industry in Bangladesh plays a crucial role in economic growth and simultaneously creates numerous employment opportunities. The poultry industry, as a fundamental part of animal production, is committed to supplying the nation with a cheap source of good quality nutritious animal protein in terms of meat and eggs. Two main systems of poultry production are common in Bangladesh nowadays: commercial poultry production – where birds are kept in total confinement, and traditional scavenging or semi-scavenging poultry production. Approximately 20% of the protein consumed in Bangladesh originates from poultry. With the exception the dip in production due to the recent Avian Influenza outbreak, the growth of this industry in terms of standards of commercialization, is very rapid. A gap still exists between the requirement and supply of poultry meat and eggs within the recent frame-work of the informal marketing system that is currently used. Among poultry species, the chicken population is dominant over others, at almost 90%, followed by ducks (8%) and a small number of quail, pigeons and geese. Free range ‘backyard’ and scavenging poultry, that are traditionally reared by rural women and children, still play an important role in generating family income, in addition to improving the family's diet with eggs and meat. Productive and reproductive performance of indigenous birds is relatively very low (35–40 eggs and 1–1.5 kg meat per bird per year), but genetic improvements by selective breeding, along with adequate nutrition and proper management, looks promising and quite possible. Commercial poultry production in Bangladesh, is conducted on an industrial scale and is growing tremendously in spite of recent difficulties but is expected to make a significant contribution to the economic development of the country. A national poultry policy is expected to be approved by the government shortly, which, when implemented, will improve the organization of production and marketing, allowing increased stability and security of output throughout the year. In addition, efforts should be taken to ensure safety standards of poultry meat and eggs for human consumption. Experts from the government, research institutes, universities, NGOs and other relevant sectors need to work in a collaborative manner in order to allow sustainable production and fight challenges jointly when they appear from time to time. Corresponding attention to research and development will allow the poultry sector to flourish in Bangladesh. As government funding is limited, industrialists need to come forward either to establish their respective research facilities or to provide funds to universities and research institutes in order to undertake research works of national and international importance.

Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents

Most older children and adolescents in the United States currently do not achieve the recommended intake of calcium. Maintaining adequate calcium intake during childhood and adolescence is necessary for the development of peak bone mass, which may be important in reducing the risk of fractures and osteoporosis later in life. Optimal calcium intake is especially relevant during adolescence, when most bone mineral accretion occurs. Because of the influence of the family's diet on the diet of children and adolescents, adequate calcium intake by all members of the family is important. Assessment of calcium intake can be performed in the physician's office. A well-rounded diet including low-fat dairy products, fruits, and vegetables and appropriate physical activity are important for achieving good bone health. Establishing these practices in childhood is important so that they will be followed throughout the life span.

Food Center participants' nutrition knowledge and self-perceived quality of diet

Those with low incomes face various difficulties in maintaining a nutritionally adequate diet. During the past two decades, the number of people living below the Federal poverty levels has increased substantially. The purpose of this study was to determine the Pasadena/Altadena (Los Angeles County) Food Center recipients' perception of the quality of their own and their family's diet, and to assess nutrition knowledge. This information was deemed necessary in order to intervene with an appropriate nutrition education program. Participants in this study were 207 food recipients of two Food Centers of the Community Housing Services (CHS) in the Pasadena/Altadena community of Los Angeles County of Southern California. The Food Center participants were queried as to self-perceived quality of their, and their family's, diet. In addition, a short nutrition knowledge questionnaire was administered. Approximately 1 3 of the respondents rated their diet as good or excellent while the rest (67.6%) rated the quality of their diet as fair, poor or very poor. The Food Center recipients' nutrition knowledge was deemed very poor, with 70% of the respondents answering only three, or fewer than three, of the eight questions correctly. This information will be utilized to set up a nutrition education intervention for the Food Center participants.

Breast milk or animal-product foods improve linear growth of Peruvian toddlers consuming marginal diets

Although breast-feeding is widely accepted as important for infant health, its benefits during the second year of life have been questioned. We analyzed data from 107 breast-fed and weaned Peruvian children living in a periurban community to determine whether breast milk contributed to improved linear growth between 12 and 15 mo of age. Breast-feeding frequency was self-reported; intakes of complementary foods and animal products were estimated from a food-frequency survey. Multivariate-linear-regression analysis was used to predict the length of the children at 15 mo of age. Determinants of length included length and weight-for-length at 12 mo of age (US National Center for Health Statistics standards), interval between 12- and 15-mo measurements, breast-feeding frequency, incidence of diarrhea, and intakes of complementary and animal-product foods. Complementary foods, animal-product foods, and breast milk all promoted toddlers' linear growth. In subjects with low intakes of animal-product foods, breast-feeding was positively associated (P < 0.05) with linear growth. There was a 0.5-cm/3 mo difference in linear growth between weaned toddlers and children who consumed the average number of feedings of breast milk. Linear growth was also positively associated with intake of animal-product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in subjects with high complementary-food intakes. When the family's diet is low in quality, breast milk is an especially important source of energy, protein, and accompanying micronutrients in young children. Thus, continued breast-feeding after 1 y of age, in conjunction with feeding of complementary foods, should be encouraged in toddlers living in poor circumstances.

Development of a Curriculum to Lower Dietary Fat Intake in a Multiethnic Population with Low Literacy Skills

Low-literate, low-income populations face unique issues as they attempt to modify their diet to lower risk of chronic disease. The goal of the Stanford Nutrition Action Program (SNAP) was to design a curriculum that would address such issues and stimulate reduction of dietary fat. Initial focus groups and pilot tests were conducted to assess nutrition knowledge, interests, and dietary habits of a multiethnic, low-literate population. These investigations revealed that a nutrition education curriculum tailored to a population with low literacy skills would need to address the taste, cost, and convenience of low-fat foods, and teach participants how to incorporate low-fat foods and cooking methods into their family's diet with minimal disruption. These findings, combined with published data on food intake and preferences, were used to design the SNAP curriculum. The SNAP classroom curriculum operationalized principles of adult education, constructs from social learning theory, and followed established national guidelines on how to develop appropriate print materials for low-literate adults. Each of its six lessons included role modeling, goal setting, problem solving, group activities, and skills building tasks; many included SNAP videotapes, food demonstrations, and posters that enhanced group discussions. Print materials were written at or below the 5th grade reading level. The SNAP curriculum combined interactive teaching techniques and behavior change methods to successfully teach and stimulate the interest of low-literate, low-income population to overcome barriers to reducing fat.