Nutrition Behavior Change Research Articles

Enhancing Frailty Status and Health-Related Quality of Life in Community-Dwelling Frail Older Adults

Introduction: Frailty poses a significant concern among older adults residing in the community, impacting their health and quality of life. This study investigated the effectiveness of the FANS in addressing frailty and enhancing health-related quality of life. The study aimed to evaluate the effects of a 6-month FANS on frailty status and health-related quality of life in community-dwelling frail older adults, and to compare the effects on fall efficacy, pain intensity, daily activities, stages of physical activity and nutrition behavior change, and satisfaction following the intervention. Methods: A quasi-experimental design was used to assess the FANS among frail older adults. The intervention, based on the Transtheoretical Model, was conducted in a mixed setting, combining in-person sessions held at a community care center and remote group care delivered through the LINE app. The experimental group (n=43) received the FANS intervention, while the control group (n=38) continued with standard health promotion activities provided at the same community care center. Intention-to-treat analysis evaluated the intervention's impact. Measurements were taken before the intervention and at the 3-month and 6-month marks to assess changes in frailty status, health-related quality of life, fall efficacy, pain intensity, and daily activities. Behavior change stages and satisfaction were monitored using the Fitness and Nutrition for Seniors Behavior Change Stages and Satisfaction Scale. Results: Within the experimental group, significant improvements were observed over time across multiple measures, indicating intra-group effects, including frailty, overall health-related quality of life, fall efficacy, pain intensity, and daily activities. Between-group effects demonstrated statistically significant differences in daily activities. Time and group effects showed statistically significant improvements in frailty at three months and six months post-intervention. Following the intervention, a substantial percentage of participants in the experimental group progressed in behavior change stages related to physical activity and diet, with 83.72% in the action and maintenance stages for physical activity behavior change and 81.40% in those for dietary behavior change. The overall satisfaction rating for the program was 9.25 ± 0.24. Conclusion: The FANS is a feasible and innovative community health promotion initiative tailored specifically for frail older adults residing in the community, particularly during a pandemic. This program has demonstrated significant improvements in frailty status, health-related quality of life, fall efficacy, pain intensity, and daily activities among community-dwelling frail older adults. Moreover, the program has facilitated notable advancements in behavior change stages, supporting community-dwelling frail older adults in adopting and maintaining healthy behaviors effectively.

Building a rights-based approach to nutrition for women and children: harnessing the potential of women’s groups and rights-based organizations in South Asia

Women face numerous gender-based barriers that hinder their access to resources, nutritious foods, nutrition services, and maternity entitlements. Evidence shows that certain types of women’s groups can improve women’s access to resources and social capital and in some approaches also improve health and nutrition outcomes. Women’s rights-based organizations in South Asia have a longstanding tradition of collective action toward gender equality. Women’s rights-based organizations work in areas such as microfinance, livelihoods, women’s rights, health, and combating violence against women. In this perspective article, we explore how women’s groups and rights-based organizations can leverage their collective strength to advance nutrition outcomes for women and children. We identify seven pathways implemented through women’s groups toward improving nutrition outcomes. These pathways include (i) income generation, (ii) agriculture, (iii) health and nutrition behavior change communication and participatory learning and action, (iv) advocating for rights to better health and social services, (v) food access, (vi) cash transfers, and (vii) strengthening service delivery and fostering convergence with health systems. We also note that women’s groups have the potential to implement integrated interventions through combined food-systems-rights pathways. Investing in this area can support transforming nutrition policy from a service delivery model to a rights-based approach.

General practitioner-centered rural obesity management: Design, protocol and baseline data of the German HAPpEN pragmatic trial.

HAPpEN aims to implement and evaluate a holistic general practitioner-centered, interdisciplinary obesity management strategy in rural Germany, focusing on feasibility, health outcomes, and economic benefits. HAPpEN is a 12-month, pragmatic single-arm, multicenter trial, informed by a formative survey, and initiated in April 2023 with 98 obese participants (body mass index, BMI≥30kg/m2) in Kulmbach, Germany. The program integrates nutritional counseling, physical activity, and behavior change techniques, including smartphone-based self-monitoring. Monthly consultations help set personalized goals using a multi-stage grading scale. Primary outcomes include BMI, body weight, waist circumference, heart rate, blood pressure and parameters, while secondary outcomes assess quality of life, wellbeing, health literacy, social interaction, and digital therapy support. The baseline cohort (mean age: 46.9±11.8years, 74.1% female) exhibited high obesity rates (mean BMI: 40.1±6.1kg/m2), with 48.5% classified as grade III obese. Common comorbidities were hypertension (51.8%), dyslipidemia (30.5%) and diabetes (21.8%). Chronic joint paint, mainly in the knees and hips, affected up to 82.4%. A familial aggregation of obesity, diabetes, and cardiovascular diseases was noted, alongside behavioral challenges such as lack of physical activity (81.8%) and unhealthy eating habits (56.8%). HAPpEN addresses obesity's multifactorial nature through general practitioner-led, community-based, and digital strategies to promote sustainable lifestyle changes in rural areas. The trial aims to inform primary care obesity management guidelines, focusing on improving health literacy, patient engagement, and long-term clinical benefits. German Clinical Trials Register: DRKS00033916.

Nutritional Behavior Change in Primary Care: What do you Know and What do you Need? A Qualitative Study

Nutritional Behavior Change in Primary Care: What do you Know and What do you Need? A Qualitative Study

ImpENSA eHealthy Conversation Skills training for healthcare professionals aimed at improving micronutrient status during the first 1000 days in South Africa.

Individuals' lifestyle behaviours determine health. Improving Early Nutrition and Health in South Africa ("ImpENSA"), an EU Erasmus+ co-funded project, aims to tackle the triple burden of malnutrition in South Africa through equipping healthcare professionals (HCPs) with knowledge and skills to effectively support healthy nutritional choices among pregnant women and mothers/infant caregivers. Healthy Conversation Skills (HCS) is a behaviour change intervention utilising open discovery questions, active listening, reflection on practice and goal-setting support through SMARTER (Specific, Measured, Action-oriented, Realistic, Timed, Evaluated and Reviewed) planning as core competences. We integrated HCS training delivered online (eHCS training) as practical skills training for HCPs following two eLearning modules on micronutrient nutrition and person-centred behaviour change support. In a programme pilot (2021-22) we investigated participant training experiences, application of HCS and changes in clinical practice using assessments, questionnaires, and interviews at baseline, pre- and post-training and at 3-month follow-up. Of 36 participants (mainly dietitians) initially enrolled, 27 completed eHCS training and 24 participated in the follow-up evaluation. All applied open discovery questions and listened to their patients more actively (spending less time giving information) during consultations. Many participants (63%) reported that they frequently supported their patients using SMARTER planning for a behaviour change. All reflected on their practice and how they consulted their patients. Participants gave very positive feedback on eHCS training, finding it relevant and enjoyable. Contextual (micronutrient nutrition) and theoretical (person-centred behaviour change and HCS) knowledge established prior to eHCS training enabled participants to focus during the training on practising and mastering HCS and observing others. This facilitated reflection, deepened understanding of patient-centred care and accelerated the application of HCS to implement person-centred care in their practice. We conclude that eHCS training delivered online, integrated with knowledge-based modules, can effectively enhance the way HCPs support their patients to ultimately optimise early life nutrition.

Changes in Nutrition, Food Safety, and Physical Activity Behaviors: A Comparison Between the Peak Health and Performance and Teen Cuisine Curricula

Changes in Nutrition, Food Safety, and Physical Activity Behaviors: A Comparison Between the Peak Health and Performance and Teen Cuisine Curricula

Impact of temporomandibular disorder on food preference behavior in adult male rats

ObjectiveTemporomandibular disorders (TMD) are a group of conditions affecting the jaw, surrounding muscles and associated structures. Researches indicate that TMD has implications for changes in nutritional behavior. This study investigates the impact of TMD on the food preference behavior of rats, examining various food models with differing caloric content, taste, and texture. DesignForty-two male Wistar rats (200–250 g) were divided into six groups, comprising three control and three pain or TMD groups. Induction of TMD by injection of complete Freund adjuvant (CFA) into the left temporomandibular joint (TMJ) of rat serves as a model for studying TMD. Twenty-four hours post-TMD induction, the preference of animals to foods with differences in calories, taste and texture was evaluated with the help of an automatic preference measuring device. ResultsIn terms of caloric preferences, the pain group exhibited a distinct shift towards high-calorie food. Taste preferences were marked by an increased preference for sweet food in the pain group. Texture preferences were altered, with the pain group displaying a preference for low-texture food. ConclusionTMD in rats leads to increased preferences for high-calorie and sweet foods, as well as altered preferences for food textures. These findings highlight the influence of TMJ pain on food preference behavior in rats.

Women improving nutrition through self-help groups in India: Does nutrition information help?

Women’s self-help groups (SHGs) are an important platform for reaching poor women in India. Despite SHGs' women-focused programming, evidence of the impact of SHG-based interventions on nutrition outcomes is limited, and most evaluations of nutrition interventions have not examined intermediate outcomes along the impact pathways or outcomes for women themselves. This paper evaluates the effectiveness of an integrated agriculture-nutrition intervention delivered through women’s SHGs in five states in central and eastern India. The interventions involved the delivery of nutrition behavior change communication to groups through participatory approaches, community engagement around key issues, and the strengthening of collective organizations. Our analysis is based on three rounds of rich panel data on close to 2700 rural women and their households from eight districts in these five states and qualitative work from an accompanying process evaluation. Using difference-in-difference models with nearest neighbor matching methods, we present results on women’s anthropometry and diet-related outcomes.We do not observe any improvements in women’s BMI or overall dietary diversity. Although more women in the nutrition intensification arm consumed animal source foods, nuts and seeds, and fruits, this was not enough to increase overall dietary diversity scores or the proportion of women achieving minimum dietary diversity. We measure intermediate outcomes along the program’s impact pathways and find improvements in household incomes, cultivation of home gardens, and utilization of government schemes but not in women’s empowerment. The lack of improvement in anthropometry and diets despite changes in some intermediate outcomes can be attributed to several factors such as low implementation intensity, poor facilitator capacity and incentives, the lack of relevance of the BCC topics to the average SHG member, and resource and agency constraints to adoption of recommended practices. Although we do not have data to test the parallel trends assumption and so do not interpret our results as causal, these findings do suggest that optimism about using group-based platforms needs to be tempered in resource-poor contexts.

Culinary Medicine and Teaching Kitchens: Dietitians Leading Innovative Nutrition Training for Physicians.

The objective of this evaluation was to determine the impact of a pop-up Teaching Kitchen (TK) at a national cardiovascular conference. The 60-minute session was hosted in a hotel conference room and led by two registered dietitians. Participants prepared 12 recipes, enjoyed a family-style meal, and explored nutrition behaviour change strategies for patients. Using Likert-scaled and open-ended questions, pre-/post-online surveys assessed change in perceived nutrition counselling skills, attitudes, and confidence; post-survey also assessed effectiveness of session components and further training needs. Pre-survey response was 72% (18/25). Twenty-one participants attended the event (14 pre-registrants, six from waitlist, and five drop-ins); 81% completed the post-survey. Positive shifts were reported in nutrition competence, particularly attitudes towards using recipes in nutrition counselling, and increased skills and confidence discussing eating on a budget and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting with patients. Components of the TK session that enhanced nutrition competence were key patient messages and the shared meal. Preparing and eating together in a hands-on format was most enjoyable. Promoting healthy eating behaviours requires understanding the complexity of individual and societal food literacy. With high physician interest, dietitians are well positioned to deliver culinary medicine interventions and support physicians' confidence in health promotion and chronic disease prevention and management.

Social Norms: A Missing Ingredient of Programs Seeking to Foster Women’s Agency in Nutrition

Social expectations play a crucial role in shaping dietary practices among women and children. However, despite significant attention to promoting social and behavioral change in nutrition-focused programs and research, the influence of social norms on women’s agency in enhancing nutrition practices is often overlooked. In this perspective, we advocate for a paradigm shift by incorporating a “norms aware” approach. This underscores the importance of recognizing, measuring, and addressing the societal constraints and barriers that women and children encounter in their journey to improved nutrition. Drawing on insights from the United States Agency for International Development-funded Kulawa project in Niger, we highlight the implications of using social norms diagnosis tools to understand the contextual dynamics within child-feeding practices, informing intervention design, and targeted populations. Integrating a norms perspective into nutrition programming and research does not require an overhaul, but rather a nuanced application of understanding of contextual drivers, such as social norms and agency, that have been underemphasized. We delve into the role of the socio-ecologic system, underscore the importance of addressing power imbalances related to gender and social hierarchy, and emphasize that programs targeting norms should aim for community rather than individual-level change. We provide guidance for programs and research integrating a norms perspective, as well as examples of how tools, such as the Social Norms Exploration Tool and Social Norms Analysis Plot framework, can be applied to identify and prioritize social norms, facilitating the design of “norms aware” programs. Additionally, we highlight the critical role of community engagement and discuss the value of using qualitative and quantitative approaches to document the process and outcomes of social norms research, program design, and implementation. When we recognize the role of social norms in nutrition as a missing ingredient in nutrition research, programming, and social and behavior change strategies, we create opportunities for more effective and contextually relevant research and interventions that address the complexities of enhancing nutrition practices among women and children.

Contemporary educational and behavior change strategies improve dietary practices around a match in professional soccer players.

The importance of nutrition in optimizing the health and performance of professional soccer players has been well established. Despite published practical recommendations for the dietary requirements for professional soccer players, many players fail to meet these guidelines. Thus, the primary purpose of this study was to assess the impact of targeted nutritional education and behavior change interventions on dietary intake in professional football players. Additionally, previous research within this population has reported elevations in resting metabolic rate (RMR) following match-play. Therefore, a further aim of this study was to examine whether any changes in dietary intake would influence RMR following match-play. Twenty players from the professional development phase in an English Premier League club (age: 18.4 ± 1.0 years; body mass: 76.1 ± 6.0 kg; stature: 1.80 ± 0.07 m) were randomly assigned to an "Intervention" (INT) group (n = 10), who received numerous nutritional education and behavior change interventions, or a "Control" (CON) group (n = 10), who received no nutrition support. Dietary intake was assessed daily throughout the match-week (Match Day (MD)-2, MD-1, MD, MD + 1, and MD + 2), whilst RMR was assessed on MD-1, MD + 1, and MD + 2. Statistical analyses on the intervention effects on dietary intake and RMR were carried out using a two factor (group and day) analysis of variance (ANOVA) with a subsequent Bonferroni post-hoc test. Mean energy (3393 ± 852 vs. 2572 ± 577 kcal · day-1) and CHO (5.36 ± 1.9 vs. 3.47 ± 1.1 g · kg-1 BW · day-1) intake was significantly higher (p < 0.001) in the INT vs. CON group. Furthermore, the INT group implemented nutrition periodization practices as CHO intake was significantly increased on MD-1 (7.0 ± 1.7 g · kg-1 BM · day-1), MD (7.1 ± 1.4 g · kg-1 BM · day-1) and MD + 1 (5.1 ± 0.8 g · kg-1 BM · day-1). However, the CON group did not periodize their CHO intake and failed to meet the CHO recommendations on MD-1, MD, and MD + 1 (<4 g · kg-1 BM · day-1). Compared to MD-1, the RMR increased on MD + 1 and MD + 2 in both groups, although it was only statistically significant for the INT group (MD + 1 = +243 kcal · day-1; MD + 2 = +179 kcal · day-1). The implementation of targeted nutritional education and behavior change interventions resulted in improved dietary practices in professional football players and enabled better adherence to recommended guidelines. However, despite this, RMR was still elevated in the 24-48 h following match play. Thus, in order to optimize recovery, this finding further reinforces the need for professional football players to adopt strategies to meet energy, and particularly CHO, requirements in the acute period following a match in order to account for this increase in energy requirement.

The Effectiveness of Nutritional Interventions Implemented through Lady Health Workers on the Reduction of Stunting in Children under 5 in Pakistan: The Difference-in-Difference Analysis.

In Pakistan, the 2018 National Nutrition Survey reported that 40% of children under five years old were stunted. This study assessed the effectiveness of nutritional supplementation in reducing stunting among children under five years old in two rural districts in Sindh, Pakistan. This was a mixed-method quasi-experimental study comprising intervention and control populations, with 3397 and 3277 children under five years old participating in the baseline and end-line surveys, respectively. The study areas were similar in terms of demographic and economic circumstances. In the intervention group, pregnant and lactating women (first six months post-partum) received wheat soy blend, children 6-23 months old received Wawamum (lipid-based supplement), and children 24-59 months old received micronutrient powders, all through lady health workers. This was underpinned by nutrition behaviour change communication for appropriate complementary feeding practices and hygiene promotion targeted at primary caregivers. The control group received no intervention. The impact was assessed using the difference-in-difference analysis with kernel propensity score matching to adjust the differences among the control and intervention populations. The overall DID analysis indicated that the intervention did not significantly reduce the prevalence of stunting (under 5 years) [DID = -5.1, p = 0.079]. The adjusted DID indicated a significant decrease of 13% [DID = -13.0, p = 0.001] in the number of stunted children 24-59 months of age at the endline survey. A significant reduction in underweight among children 24-59 months old was also observed (DID = -9.4%, p = 0.014). In conclusion, this evidence further establishes that nutrient uptake through an intervention for a short duration cannot effectively reduce stunting. It requires continuous nutritional supplementation for mothers during the pregnancy and an initial six months of lactation and then nutritional supplementation for children 6-59 months of age underpinned by effective behaviour change communication targeting mothers and other caregivers for improving complementary feeding practices and hygiene promotion.

Effect of a multimodal intervention in breast Cancer patients undergoing neoadjuvant therapy: A study protocol of the multimodal project

Background and aimsTo determine the effect of a multimodal intervention (nutritional behavior change and physical exercise) on quality of life, chemotherapy response rate and tolerance, histopathological level of the tumor, body composition, and biochemical parameters, in patients diagnosed with breast cancer during neoadjuvant chemotherapy treatment, and to compare them with the control group. MethodsAnticipated 80 patients diagnosed with breast cancer aged 18–70 years will be recruited for this randomized, unblinded clinical trial based on a nutritional behavior change and physical exercise in patients during the approximately 6 months in which the patient receives neoadjuvant treatment. Participants will be randomly allocated (1:1) to one of two groups (intervention or control). Primary and secondary outcomes will be assessed before the beginning and after the neoadjuvant treatment (before surgery). The primary outcome is quality of life, whereas secondary outcomes include chemotherapy response rate and tolerance, histopathological level of the tumor and body composition (i.e., visceral adipose tissue activity, bone, lean and fat masses). We will analyze blood parameters (i.e., biochemical, inflammatory, and tumor markers) as exploratory outcomes. ConclusionThis study will address the influence of a practical and viable multimodal intervention (i.e., nutritional behavior change and physical exercise) on breast cancer patients undergoing neoadjuvant chemotherapy. Given the practical viability of the intervention in real-world settings, our study holds promise for significant scientific and clinical implications.

Integrating nutrition in the Sasakawa Africa Association extension services: Knowledge, attitude and practices among smallholder farmers

This survey aimed to establish nutrition-related knowledge, attitudes and practices, and to observe how gender influences household food-related decision-making processes in the Sasakawa Africa Association (SAA) intervention areas in the Oromia and Southern Nation Nationalities and People regions of Ethiopia. The findings would inform implementation of communication for nutrition social and behaviour change among small-holder farmers as part of the SAA corporate strategy on nutrition-sensitive agriculture. The study population was smallholder farmers supported by SAA from which 311 respondents were selected through multistage sampling. Data were collected via a mixed methods approach consisting of a household survey, focus group discussions (FGDs) and key informant interviews (KIIs). Quantitative data were analysed using descriptive statistics while qualitative data was analysed using a narrative and content approach. The study focused on knowledge, attitudes and practices related to production and consumption of micronutrient-rich foods. Majority (59.5%) of the respondents were male. Men were the main decision makers on staple or commercial food crop production and proportion of produced crops to be consumed at home or sold in the market. Women mainly made decisions regarding production and consumption of fruits and vegetables, intra-household food distribution, preservation and storage. There was a lack of knowledge on iron and vitamin A fortified or biofortified sources of food. Nearly three quarters (72%) of women did not meet the minimum dietary diversity for women, a proxy indicator of adequacy of micronutrient intake and diet quality. The mean dietary diversity score was 3.8 with animal source foods being the least consumed. Not having sufficient money to buy food, unavailability of different food groups and poor intra-household food distribution were among the key reasons for lack of diverse diets. Majority of the respondents were aware of the importance of production and consumption of micronutrient-rich foods. However, there was a gap in practice and awareness about biofortified and fortified foods. While most of the respondents had produced fruits and vegetables in home gardens in the three months prior to this survey, more than half (54%) of the respondents thought it was not likely that they would produce fruits and vegetables for home consumption. More targeted nutrition campaigns are required to increase the ability of small-holder farmers to adopt best practices while reducing the barriers associated with access and consumption. Promotion of fruit and vegetable production in home gardens could be considered as option for improving household dietary quality as well as empowering women to make more decisions. Key words: Sasakawa Africa Association, Small-holder farmers, Nutrition, Knowledge, Practices

PENGARUH KONSELING GIZI PADA IBU TERHADAP ASUPAN ZAT GIZI DAN STATUS GIZI BADUTA STUNTING

The problem of stunting occurs because children are malnourished during 1000 days of life, characterized by shorter height compared to children of the same age. Various factors cause stunting, and lack of maternal nutritional knowledge can affect maternal nutritional behavior in improper feeding. Nutrition counseling interventions were carried out for mothers so that changes in maternal nutritional behavior occur for the better. This study aimed to analyze the effect of nutrition counseling on maternal nutrition knowledge and attitudes, nutrient intake, and nutritional status of stunted toddlers. This study used a randomized control trial, which was located in 5 health centers including Puskesmas Kedungkandang, Arjuno, Ciptomulyo, Dinoyo, and Polowijen Malang City, in June-August 2023. Respondents were mothers of stunted children aged 6-24 months. The number of respondents in the treatment and control groups was 44 people each group. Statistical analysis used was the Paired Sample T-test, Wilcoxon Test, Independent Sample T-test, and Mann-Whitney U test. There was a significant difference in the mean between the two groups on nutritional knowledge (p=0.000), respondents' attitudes (p=0.000), nutrient intake of energy (p=0.000), carbohydrate (p=0.021), and protein (p=0.000), and nutrition status of stunted toddlers (p=0.000). Nutrition counseling can improve nutrition knowledge, maternal attitudes, nutrient intake energy, carbohydrates, and protein, and nutrition status of stunted toddlers.

Effect of behavior change communication through the health development army on birth weight of newborns in Ambo district, Ethiopia: a cluster randomized controlled community trial

BackgroundPoor behavior change communication on maternal nutrition and health throughout pregnancy is thought to be to blame for Ethiopia’s high rate of low birthweight babies, and this has implications for neonatal morbidity and mortality. The effect of behavior change communication on birth weight in the study district was not examined. This study was to determine whether improving neonatal birthweight using nutrition and health behavior change communication (NHBCC) interventions was successful.MethodsA cluster randomized controlled trial was conducted in the Ambo district of Ethiopia from May 5, 2018–January 30, 2019. At the beginning of the study, 385 women in the 24 intervention groups and 385 women in the 24 control groups were recruited. In the intervention group, health development armies delivered the NHBCC core message every two weeks for four months by grouping pregnant women in specific clusters. Pregnant women in the control group received the routine treatment offered by the healthcare system during their ANC visits. Within 24 h of birth, the birthweights of 302 and 292 neonates in the intervention and control groups, respectively, were measured at the end point of the study. A binary generalized linear model analysis was employed.ResultThe control group had a larger absolute risk of neonates with low birthweight (0.188 vs. 0.079, p < 0.001) than the intervention group. Pregnant women in the intervention group had an absolute risk difference of 10.9% for low birthweight. Pregnant women who received the intervention were 62% less likely to have low-risk birthweight compared to pregnant women who were in the control group (ARR = 0.381, 95% CI: 0.271–0.737).ConclusionNutrition and health behavior change Communication by health development armies improves birthweight. The findings demonstrated that to improve birthweight, NHBCC must be administered to pregnant women in groups via health development armies in their communities.Trial registration numberPACTR201805003366358.

Effect of nutrition counseling on nutritional status and gestational weight gain of pregnant adolescents in West Arsi, Central Ethiopia: a cluster randomized controlled trial

When pregnancy occurs in adolescence, the growth and development of the mother and fetus may be impaired due to strong competition for nutrients between the still-growing adolescent and the fetus. Pregnant adolescents constitute an underserved population; they lack adequate nutritional knowledge. Therefore, this study investigated the effect of nutritional behavior change communication (NBCC) through alliance for development (AFD) on the nutritional status and gestational weight gain (GWG) of pregnant adolescents. A two-arm parallel cluster randomized controlled community trial was conducted in the West Arsi Zone, central Ethiopia, from August 2022 to July 2023. The nutritional status of the pregnant adolescent was assessed using mid-upper arm circumference. Weight was measured at baseline and at the end of the intervention. A total of 207 and 219 pregnant adolescents participated in the intervention and control clusters, respectively. The intervention started before 16 weeks of gestation, and the intervention group attended four NBCC sessions. The NBCC was based on the health belief model (HBM) and was given at the participants’ homes with their husbands. The NBCC intervention was delivered by AFDs and community-level health actors. Pregnant adolescents in the control group received routine nutrition education from the health care system. A linear mixed-effects model and difference in difference (DID) were used to measure the intervention effect after adjusting for potential confounders. After the implementation of the trial, the mean mid-upper arm circumference (MUAC) in the intervention arm significantly increased from baseline (p ≤ 0.001), 23.19 ± 2.1 to 25.06 ± 2.9 among intervention group and 23.49 ± 2.1 to 23.56 ± 2.0 among control group and the mean difference in the MUAC (DID) was 1.89 ± 2 cm (p ≤ 0.001); the mean GWG in the intervention arm significantly increased from baseline; 51.54 ± 4.7 to 60.98 ± 4.6 among intervention group and 52.86 ± 5.27 to 58 ± 5.3 among control group; the mean GWG in the intervention group was 9.4 kg, and that in the control group was 5.14 kg, and the difference in difference was 4.23 kg and this was statically significant p ≤ 0.001). This study demonstrated that the use of the HBM for NBCC delivered through the AFD was effective at improving the nutritional status and GWG of pregnant adolescents. These results imply the need for the design of model-based nutritional counseling guidelines.Clinical trial registration: PACTR202203696996305, Pan African Clinical Trials Registry, date of first registration: 16/03/2022.

Dietary diversity and associated factors among women attending antenatal clinics in the coast region of Tanzania

BackgroundAntenatal care (ANC) is crucial for reducing maternal morbidity and mortality, especially in low-resource settings. During antenatal care, women are provided with resources for enhancing their dietary diversity, like nutrition education and counseling. Improved nutrition knowledge influences positive nutritional behavior change, like women’s improved dietary diversity, which may increase the likelihood of a healthier pregnancy and delivery experience.ObjectiveThis study aim was to assess dietary diversity and associated factors among pregnant women attending antenatal care in the Coast region of Tanzania.MethodsThe descriptive cross-sectional study design was used to assess dietary diversity and associated factors among 338 pregnant women. A semi-structured questionnaire collected information from pregnant women on social demographic characteristics, nutrition knowledge and dietary diversity. Women were classified as having a varied diet if they had consumed at least five of the ten food groups over the previous twenty-four hours. Multivariable logistic regression analyses were used to identify predictors of dietary diversity in pregnant women.ResultsOnly 28% (95% CI: 23.5–33.1) (n = 95) of pregnant women met the minimum dietary diversity, and 18% (95% CI: 13.8–21.9) (n = 59) were considered to have a high level of nutrition knowledge. Living near a health facility (AOR = 1.77, CI 1.02, 3.06), having high nutrition knowledge (AOR = 2.58, 95% CI: 1.36, 4.89), and being pregnant for the first time (AOR = 2.44, 95% CI: 1.09, 5.44) were associated with adequate dietary diversity.ConclusionPregnant women in the study were found to have low knowledge about nutrition and inadequate dietary diversity intake. The findings underscore the need to improve nutrition knowledge provision in antenatal clinics by emphasizing the importance of a diversified and high-quality diet. Healthcare providers in antenatal care clinics should consistently provide nutrition education and counseling to pregnant women and promote their diversified food consumption. Such knowledge may eventually promote healthier pregnancy and child development by curbing the nutritional deficiencies experienced during pregnancy.

Change in Nutrition Behavior After Participating in an Obesity-Related Cancer Education Program in El Paso, Texas.

Background Roughly 25% of the U.S- Border city, El Paso, Texas is obese. Obesity is a major risk factor for 13 cancers. Cancer is the leading cause of death in El Paso. Therefore, there is a growing urgency to implement evidence-based programs that support behavioral change that helps curb the impact of obesity in El Paso and the U.S.-Mexico border region. Purpose This study aimed to assess the effectiveness of an obesity-related cancer prevention program (Pasos Para Prevenir Cancer (PPPC) on changes in participant nutrition behaviors. Methods Culturally tailored, theory-based education was provided to adults through the PPPC program. A total of 256 PPPC participants agreed to take part in our program evaluation. Participants were asked to complete a survey at baseline and 6 months after they completed the program. Session included topics on obesity-related cancers, assessing your obesity risk, measuring body fat, SMART goal setting, and how to find the right type of physical activity. For this report we used the Food Frequency Questionnaire (FFQ) data to assess changes between baseline and six months. We also used perceived dietary barriers as moderators on the relationship between program participation and nutrition behaviors. Results Most participants (92.2%) identified as being of Mexican American descent, were between the ages of 41-75 years of age (n = 165) and identified as females (n = 225). 48.1% of the participants were born in Mexico while 50.4% were born in the U.S. Approximately 35-51% of participants improved and sustained their intake of healthier foods at 6 month follow up. Specifically, there was a statistically significant shift from higher fat and sugar content foods to light and low-fat foods, and fruits and vegetables. Participants also increased their consumption of ground chicken, lean red meat, and seafood. A key modifier in this relationship is perceived health risk. Conclusion Latinos on the U.S.-Mexico border ascribe to a healthy living mindset. In general, they frequently eat fruits and vegetables. Participation in PPPC increased perceived barriers to healthy living around cost and convenience and enhanced decision-making around healthier options. Participants responded to our adapted evidence-based program resulting in sustained changes in nutrition behaviors. Using adapted evidence-based strategies developed outside of the U.S.-Mexico border region is a feasible approach to address persist health disparities.

Assessment of the changes in nutritional and psychological behaviors of Saudi adults related to the impact of the coronavirus infectious disease-19 curfew: A cross-sectional study

Background/aim In response to the coronavirus infectious disease - 19 (COVID-19) spread, the Saudi government enforced a nationwide curfew, which in turn has influenced the dietary habits and psychological behaviors of the Saudi population. Data regarding the impact of curfew on Saudi adults are lacking. Thus, the study aims to assess the changes in nutritional and psychological behaviors of Saudi adults related to the impact of the coronavirus disease -19 curfew. Patients and methods This study is a cross-sectional online study among Saudi adults aged between 25 and 65. This study includes 1040 adults from different regions of Saudi Arabia. Data regarding nutritional behaviors, physical activity, weight changes, and psychological behaviors were collected via an online questionnaire. The psychological behaviors during the curfew were assessed by Depression, Anxiety, and Stress Scale-21. The Chi-square test was used to test for the presence of an association between the diferent categorical variables. Results Out of 1040 participants, 76.9% were female, and 36.4% were aged between 46 and 65 years. Our results showed an increase in intake in dessert by 54.2%, salty snacks by 52.1%, and appetite by 48.9%. Over 24.7% and 45% of participants reported eating more meals and snacking, respectively. Half of the participants gained weight, especially among male participants (P=0.012). Physical activity had also decreased among male participants (P&lt;0.001). The prevalence of moderate to extremely severe anxiety, stress, and depression during the curfew was noted to be 13.8, 3.7, and 8.4%, respectively, without any gender difference. Conclusion Public health officials should focus on increasing awareness of healthy eating habits and provide psychological support and emphasizing physical activities during the curfew.