Nutrition Education Counseling Research Articles

Abstract 18229: The Effectiveness of a Student-Delivered Weight Loss Program in a High-Risk Urban Practice

Introduction: Obesity is a global epidemic contributing to CVD, the leading cause of death worldwide. Diet, exercise, and lifestyle are crucial to CVD prevention and treatment. The Healthy Eating Index (HEI) is a 13-component dietary analysis tool based on the Dietary Guidelines for Americans, with higher scores associated with lower CVD risk. Calculating the HEI involves a 24-hour food recall and complex scoring. The Diet Risk Score (DRS), a 9-question, efficient alternative screening tool, has been validated against the HEI. JeffWLP, a unique low-cost, long-term student-delivered nutrition education program, evaluates improvement in DRS. Hypothesis: JeffWLP participants in JeffWLP would demonstrate significant weight loss, increased physical activity, and improved DRS in urban at-risk patients. Methods: In this randomized controlled trial, 30 obese adults from an underserved urban population were randomized to intervention (n=18) or control/usual care (n=12) groups. Mean age was 46 +/- 13 years. 80% were African American, and 90% were female; mean baseline BMI was 38 +/- 5. Mean socioeconomic status, self-assessed using the MacArthur Scale, was 6 (maximum 10). JeffWLP includes 12 core weekly group and individual nutrition education counseling sessions, meal replacements, and an exercise component, followed by unlimited bimonthly maintenance counseling. Vitals were obtained pre, mid, and post-core intervention. Results: JeffWLP participants achieved mean weight loss of 6.1 +/- 7.8 lbs (p=0.01), or 2.7 +/- 3.3% body weight (p < 0.01) in 12 weeks. Mean DRS improved by 7 +/- 6 points (p <0.001). Number of weekend steps walked increased by 3500 +/- 3150 (p = 0.016). Pilot JeffWLP patients (n=7), sustained weight loss of 4.8 +/- 8.1 lbs, 285 days after enrollment (p = 0.17). Conclusions: Our study demonstrates the cost-effectiveness of JeffWLP for improving weight loss, exercise, and dietary risk in 12 weeks. We anticipate additional sustained improvements in this ongoing study with double the sample size; this additional data will be available at the AHA meeting. JeffWLP empowers medical students to improve health outcomes in disadvantaged, at-risk underserved populations affordably, addressing critical health disparities.

Acceptability and feasibility of video-based health education for maternal and infant health in Dirashe District, South Ethiopia: A qualitative study.

Evidence about innovative methods to facilitate nutrition education counseling and promote the intended behavior change at scale is limited. We assessed the acceptability and feasibility of a video-based health education intervention aiming to promote community care for pregnant women, mothers, and infants in the Dirashe District, Ethiopia. Using a phenomenological study design, the experiences of study participants in a trial testing the effectiveness of video-based health education on birth outcomes and nutritional status of mothers and their infants six months postpartum were assessed. Focus group discussions (FGDs) and key informant interviews (KIIs) were used to collect the data. The study was conducted in the Dirashe District, South Ethiopia. Five FGDs and 41 KII were conducted among video implementers, mothers, nurses, and health extension workers (HEWs) in eight intervention villages. All data were collected with a tape recorder. The tape-recorded data were transcribed and then translated into English. Data were analyzed using thematic content analysis. The videos delivered messages about nine themes on health, nutrition, and hygiene related to mothers and infants. Overall, the video-based health education interventions was acceptable and feasible. Messages delivered were found to be clear, easily understandable, culturally acceptable, and relevant to the needs of the mothers. Feasibility was affected by the nature of the work, lack of help, and overlapping duties of the HEWs. The video-based health education intervention was acceptable and feasible. It was suggested that determining a common location/venue to show the videos, involving husbands, and involving HEWs could improve the intervention. Trial registration: The effectiveness "parent" study was registered as a clinical trial with the U.S. National Institute of Health (www.ClinicalTrials.gov; NCT04414527). The qualitative study included recipients from the same cohort (participating mothers from the intervention group), in addition to video implementers, health extension workers the Health Development Army, and nurses from the intervention communities.

A food-system approach to addressing food security and chronic child malnutrition in northern Vietnam

Despite recent improvements in health, Vietnam continues to face significant problems with food security and chronic malnutrition among children. In the Northern Mountainous Region, small-scale farmers and ethnic minority groups are particularly hit hard. Anemia is present in almost half the local population of children under two, and close to 20% of children experience stunted growth. Anemia and stunting can cause irreversible deficiencies in learning and child development. Fortification of food products that are complementary to breast milk has been identified as an option to intervene and tackle chronic child malnutrition, particularly in situations requiring rapid results. Our paper describes how the ECOSUN project addressed food security and chronic child malnutrition in northern Vietnam (Lào Cai, Lai Châu, and Hà Giang provinces) using a food-system approach to design and implement a viable and sustainable value chain for fortified complementary foods. Through public-private partnerships, the project procured locally grown crops from small-scale women farmers to produce affordable fortified complementary food products in a small-scale food processing plant. Social marketing campaigns and nutrition education counseling centers supported product distribution through local vendors while emphasizing and promoting the value of fortified foods for healthy child development. The ECOSUN project also aimed to contribute to the broader goal of transforming the local economy. The process, lessons, challenges, successes, and methods employed to assess and test the delivery mechanisms of the project can offer insights to researchers, program implementers, and decision-makers involved in research-integrated development projects embedded in local socio-ecological systems.

Penyuluhan Gizi Seimbang Anak Usia Sekolah Pada Siswa-Siswi SD Negeri 27 Kartiasa Kabupaten Sambas

Indonesian faces various health-related problems, one of which is the lack of balanced nutrition. Nutrients can affect the level of health, intelligence, and high work productivity. Counseling at SD Negeri 27 Kartiasa, Sambas Regency aims to increase the knowledge of elementary school children about balanced nutrition intake patterns. The method used in this activity is lecture and question and answer. The process of this activity lasts for ± 1 hour. The results of this activity showed that students at SD Negeri 27 Kartiasa were very enthusiastic in participating in counseling activities. The students listen well when delivering the material, so that there is interaction between one another. With this balanced nutrition education counseling, it is hoped that students can apply a healthy lifestyle and consume healthy food and drinks according to their needs. Through this activity, students can find out a balanced nutritional intake that should be consumed according to their age and body condition.

Adapting family-based treatment for paediatric obesity: A randomized controlled pilot trial.

This pilot study aimed to refine and test an adaption of family-based treatment (FBT) for eating disorders that addressed the distinct clinical needs of adolescents with overweight or obesity in the absence of eating disorder pathology. Our hypothesis was that FBT for paediatric obesity (FBT-PO) would be feasible to implement and superior to a nutrition education counselling (NEC) condition delivered to both parents and patients, thereby controlling for key information dissemination across groups while manipulating active therapeutic content and strategy. Seventy-seven adolescents were randomized to FBT-PO or NEC across two sites. Results supported our core prediction, in that weight status among adolescent study participants receiving FBT-PO remained stable while increasing among participants randomized to NEC. Attrition was high in both conditions. FBT-PO, while not seeming to yield a marked decrease in body mass index z-score, may arrest an otherwise-occurring weight-gain trajectory for these adolescents. This efficacy finding is consistent with the overall PO literature supporting parental involvement in the treatment of PO. Future research efforts should address retention in FBT-PO.

A comparison of beverage intakes in US children based on WIC participation and eligibility.

To compare beverage intakes for 2- to 4-year-olds based on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Data from National Health and Nutrition Examination Survey, 2005-2010 were analyzed to assess beverage intakes for 2- to 4-year-olds. Children were classified as WIC participants, low-income nonparticipants, and higher-income nonparticipants. All beverages were manually coded into 6 categories: water, milk, 100% juice, fruit drinks, soda, and low-calorie/diet drinks. Grams, calories, and percent consumers of each beverage were compared across groups. Special Supplemental Nutrition Program for Women, Infants, and Children participants had the highest 100% juice consumption (P = .001) and their milk consumption was similar to higher-income children. Higher-income nonparticipants drank significantly less fruit drink (P < .001) and soda (P = .001) than both the WIC participants and low-income nonparticipants. Participation in WIC was related to higher intakes of the beverages provided in food packages for 2- to 4-year-olds. Intakes of fruit juice and sugar-sweetened beverages should be addressed during the WIC nutrition education counseling sessions.

Effect of Nutrition Education Counseling Training on Pediatric Residents' Knowledge and Counseling Practices and on Caregivers' Knowledge and Complementary Feeding Practices

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Psychological and Social Predictors of Changes in Fruit and Vegetable Consumption Over 12 Months Following Behavioral and Nutrition Education Counseling.

This study assessed psychological and social factors predicting 12-month changes in fruit and vegetable consumption achieved by 271 men and women from a low-income population randomized to brief behavioral and nutrition education counseling. Greater increases in fruit and vegetable intake were achieved in the behavioral than in the nutrition education condition (1.49 vs. 0.87 portions per day, p=.021). Increases were predicted by baseline social support for dietary change but not by baseline psychological measures. However, short-term (8-week) changes in dietary self-efficacy, encouragement, anticipated regret, perceived benefits, and knowledge of recommended intake predicted 12-month changes in fruit and vegetable consumption independently of gender, age, ethnicity, income, and baseline intake. These factors accounted for 51% of the superiority of behavioral counseling over nutrition education.

Using Clinical Pathways to Improve Timeliness and Consistency of Initial and Follow-Up Outpatient Nutrition Care for Diabetics

Clinical pathways have historically been used to aid in continuity and standardization of medical treatment. They can also be useful tools for monitoring patient status to improve overall outcome of care. A retrospective record review (n=68) evaluated the presence of a clinical pathway in the outpatient record and the accuracy of its completion. In addition, the time from diagnosis until receiving nutrition education counseling and HgbAlC levels were monitored. Results indicated within 3 months 92% of diabetic patients who had a clinical pathway in their chart attended nutrition counseling. For patients who had no clinical pathway in the record, within 3 months 44% had consulted nutritional medicine. Patients who attended nutrition education have HgbAlC levels monitored within 6 months of attending a diabetes education class. Those patients who only attended 1 education class (n=18) had an average HgbAlC decrease of 0.3, those patients attending an initial and one follow-up education session saw an average decrease HgbAlC of 1.39 (n=22). Through consistent usage of the clinical pathway, nutrition educators can reach a larger percentage of diabetic patients. In addition, the clinical pathway can be used to identify patients who skip their initial and follow-up nutrition consults. The clinical pathway is a successful tool to promote timely and consistent nutrition care for diabetics.

Persons with diet-related diseases

Dietitians and nurses frequently respond to client questions regarding nutrition; however, only limited research data are available on the information they provide to consumers about the controversial issue of meat in the diet. This study was designed to determine the level of knowledge of dietitians and nurses regarding meat, and to compare the attitudes and meat consumption patterns of the two groups. Mailed surveys were returned by 457 Missouri dietitians and 581 nurses. Dietitians were more knowledgeable about meat than nurses; only 80% of the nurses identified beef as an important source of iron, compared with 98% of the dietitians. More dietitians than nurses correctly estimated the calorie content of 3 oz of beef, although the majority of both dietitians and nurses overestimated the calories in meats. Both nurses and dietitians reported decreasing their own consumption of pork, eggs, beef, and cheese over the past three to five years and increasing their consumption of chicken and fish; however, nurses reported greater dietary changes. In contrast to nurses, dietitians believed that information from meat industry groups was useful. Almost all dietitians agreed with the statement that beef could be part of a healthful diet. Overall, dietitians appeared to view the concept of meat as a part of a healthful diet more favorably than did nurses.Les diététistes et les infirmiers (infirmières) ont souvent à répondre à des questions posées par leurs clients sur la nutrition; mais on ne dispose que de peu de données de recherche sur l’information qu'ils donnent aux consomateurs sur la question controversée de la place de la viande dans l’alimentation. La présente étude avait pour but d’identifier le niveau des connaissances de diététistes et d’infirmiers (infirmières) sur la viande et de comparer les attitudes et la consommation de viande de ces deux groupes. L’enquête a été faite par la poste dans l’état du Missouri et le questionnaire a été rempli et retourné par 457 diététistes et par 581 infirmiers (infirmières). Les connaissances des diététistes sur la viande étaient supérieures à celles des infirmiers (infirmières): seulement 80% de ces derniers ont identifié le boeuf comme une source importante de fer, par rapport à 98% des diététistes. Lavaleur énergétique de 3 onces de boeuf a été correctement estimée par une plus grande proportion de diététistes que d’infirmiers (infirmières), quoique cette valeur ait été surestimée par les deux groupes. Les infirmiers (infirmières), comme les diététistes, ont rapporté avoir diminué leur propre consommation de porc, d’oeufs, de boeuf, et de fromage au cours des dernières trois à cinq années, et avoir augmenté leur consommation de poulet et de poisson, mais ces changements étaient plus marqués chez les infirmiers (infirmières). Contrairement aux infirmiers (infirmières), les diététistes croyaient que l’information provenant des industries de la viande était utile. Presque tous les diététistes étaient d’accord pour dire que le boeuf pouvait être partie d’un régime sain. Dans l’ensemble, les diététistes paraissaient considérer plus favorablement que les infirmiers (infirmières) l’idée que la viande puisse faire partie d’un régime sain.Dietistas y enfermeras con frecuencia respon-den a preguntas de los clientes con respecto a nutrición; sin embargo, solamente datos de investigación limitados se hallan disponibles en la información que ellos proporcionan a los consumidores acerca del asunto controversial de la carne en la dieta. Este estudio fué diseñado para determinar el nivel de conocimiento de dietistas y enfermeras respecto a la carne y para comparar las actitudes y patrones de consumo de carne de los dos grupos. Encuestas enviadas por correo fueron comple-tadas por 457 dietistas y 581 enfermeras de Missouri. Los dietistas mostraron tener mayor conocimiento acerca de la carne que las enfermeras; solo 80% de las enfermeras identificaron la carne de res como una fuente importante de hierro, comparado con 98% de los dietistas. Mas dietistas que enfermeras estimaron correctamente el contenido calórico de 3 onzas de carne de res, aunque la mayoría de ambos, dietistas y enfermeras sobrestimaron las calorías en la carne. Ambos enfermeras y dietistas reportaron una reducción en su consumo propio de carne de cerdo, huevos, carne de res y queso en los pasados tres a cinco años, y un incremento en su consumo de pollo y pescado; sin embargo, las enfermeras reportaron un mayor cambio dietario. En contraste con las enfermeras, los dietistas consideraron la información de grupos de la industria de la carne como útil. Casi todos los dietistas estuvieron de acuerdo con la declaración de que la carne de res podría ser parte de una dieta saludable. En general, los dietistas parecieron considerar el concepto de la carne como parte de una dieta sana mas favorablemente que las enfermeras.