Nutrition Health Promotion Research Articles

Impact of Health Promoting Nutrition Intervention Package on Severe Malnutrition among Under-Five Children in Rural Northern India

Impact of Health Promoting Nutrition Intervention Package on Severe Malnutrition among Under-Five Children in Rural Northern India

Perspective: Integration to Implementation (I-to-I) and the Micronutrient Forum—Addressing the Safety and Effectiveness of Vitamin A Supplementation

ABSTRACTAn ongoing challenge to our ability to address the role of food and nutrition in health promotion and disease prevention is how to design and implement context-specific interventions and guidance that are safe, efficacious, and avoid unintended consequences. The integration to effective implementation (I-to-I) concept is intended to address the complexities of the global health context through engagement of the continuum of stakeholders involved in the generation, translation, and implementation of evidence to public health guidance/programs. The I-to-I approach was developed under the auspices of the Micronutrient Forum and has been previously applied to the question of safety and effectiveness of interventions to prevent and treat nutritional iron deficiency. The present article applies the I-to-I approach to questions regarding the safety and utility of large-dose vitamin A supplementation programs, and presents the authors’ perspective on key aspects of the topic, including coverage of the basic and applied biology of vitamin A nutrition and assessment, clinical implications, and an overview of the extant data with regard to both the justification for and utility of available intervention strategies. The article includes some practical considerations based on specific country experiences regarding the challenges of implementing vitamin A–related programs. This is followed by an overview of some challenges associated with engagement of the enabling communities that play a critical role in the implementation of these types of public health interventions. The article concludes with suggestions for potential approaches to move this important agenda forward.

Forced international migration for refugee food: a scoping review.

Recent crisis and conflicts in African countries, the Middle East and the Americas have led to forced population migration and rekindled concern about food security. This article aims to map in the scientific literature the implications of forced migration on food and nutrition of refugees. Scoping Review, and database search: databases: PubMed Central, LILACS, SciElo, Science Direct and MEDLINE. Languages used in the survey were: English, Portuguese and Spanish, with publication year from 2013 to 2018. 173 articles were obtained and after removing of duplicates and full reading, 26 articles were selected and submitted to critical reading by two reviewers, resulting in 18 articles selected. From the analysis of the resulting articles, the following categories emerged: Food Inequity; Cultural Adaptation and Nutrition; Emerging Diseases and Strategies for the Promotion of Nutritional Health. Food insecurity is a marked consequence of forced international migration, and constitutes an emerging global public health problem, since concomitant with increasing population displacements also widens the range of chronic and nutritional diseases.

The influence of knowledge and attitude of female adolescents on Fe tablet consumption at Public Senior High School 1 of Gorontalo City, Indonesia

Female undergo menstruation, pregnancy and breastfeeding, which bring about the need to consume blood cell tablet in order to provide extra iron and further replace lost blood, as a preparation through adolescence. Furthermore, females tend to suffer from anemia, exhibit retarded learning, working competence, quality of human resources and overall wellbeing of their offspring hence the promotion of nutritional status and health is essential (Warsiti, 2013). This study therefore aims to investigate the effect of knowledge and attitudes of female adolescents on the consumption of Fe tablet at Public Senior High School 1 of Gorontalo, applying a quantitative approach with cross-sectional method. With a sample of 72 students, the study involved the use of a questionnaire to obtain data, which were analyzed using the Fisher Ex cact (X2) test at the significance level of 95% (α=0.05). The analysis results revealed no influence of knowledge, toward the behavior of consuming Fe tablet with p-value = 0.355. Furthermore, there was a correlation between attitudes and consumption behavior, with p-value = 0.003 among young women in Public Senior High School.

LC-ESI-QTOF/MS Characterization of Phenolic Compounds in Palm Fruits (Jelly and Fishtail Palm) and Their Potential Antioxidant Activities.

Palm fruits have gained growing attention for their nutrition values and health promotion perspectives. They have a diverse range of bioactive compounds including carotenoids, vitamins, dietary fibres and especially polyphenolic compounds. These polyphenolic compounds contribute to the putative health benefits of palm fruits. Nevertheless, the detailed information about these polyphenols in palm fruits is limited. The present work was conducted to comprehensively characterize polyphenols in two palm fruits, jelly palm (Butia ordorata) and fishtail palm (Caryota uren), using liquid chromatography electrospray ionization quadrupole time-of-flight mass spectrometry (LC-ESI-QTOF/MS) and assess their antioxidant potential. The total phenolic content (TPC), total tannins content (TTC), 2,2-diphenyl-1-picrylhydrazyl (DPPH) antioxidant assay and 2,2′-azinobis-(3-ethylbenzo-thiazoline-6-sulfonic acid) (ABTS) scavenging abilities and ferric reducing antioxidant power (FRAP) were higher in the jelly palm fruit while total flavonoid contents (TFC) were higher in the fishtail palm. The LC-ESI-QTOF/MS tentatively identified a total of 86 phenolic compounds in both jelly and fishtail palm fruits. Although both palm fruits exhibited different phenolic profiles, hydroxycinnamic acids and flavonols were the most common in both. In high performance liquid chromatography photodiode array (HPLC-PDA) quantification, 4-hydroxybenzoic acid (317.46 ± 4.68 µg/g) and catechin (4724.00 ± 32.39 µg/g) were the most abundant phenolic acid and flavonoid quantified in the jelly palm fruit, respectively. Quercetin (557.28 ± 7.81 µg/g) and kaempferol 3-O-glucoside (220.99 ± 2.06 µg/g) were the most abundant flavonoids quantified in the fishtail palm. Our study indicates that palm fruit is a good source of polyphenols and has strong antioxidant potential for health promotion. Furthermore, this study provides the scientific basis for an exploitation of jelly and fishtail palm fruits in the food, pharmaceutical and nutraceutical industries.

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

PROTOCOL: The effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in low- and middle-income countries.

Dietary intake is compromised among elderly living in agricultural settlements

Purpose This study aims to investigate dietary intake among elderly living in agricultural settlements in comparison with a recent nutritional recommendation. Design/methodology/approach This cross-sectional study was carried out among elderly living in five agricultural settlements in Kuantan, Pahang, Malaysia. Participants were interviewed on socio-demographic information such as age, gender, marital status, smoking status, household income, education level and living status. Data on individual dietary intake were obtained through diet history method. Dietary intake data were analyzed using Nutritionist Pro software and compared to the recommended nutrient intakes (RNI) for Malaysia version 2017. Statistical analyses were performed using SPSS software version 21. Findings A total of 413 participants (male 32.4 per cent and female 67.6 per cent) with the mean age of 69.4 ± 7.9 years participated in this study. Dietary intake results demonstrated that participants did not meet the Malaysian RNI for energy and most nutrients (p < 0.05). This study also found that energy, carbohydrate, protein, fat, folate and iron intake were significantly higher in male than female (p < 0.05). Meanwhile, calcium and vitamin A intake were significantly higher in female than male (p < 0.05). Research limitations/implications Integrated nutrition education and health promotion programme with a multidisciplinary approach are essential to be designed and executed to improve dietary intake of the elderly, which can further lead to appropriate dietary practices and knowledge improvement related to healthy food choices. Factors associated with inadequate dietary intake and awareness on the importance of adequate nutrients intake among the elderly warrant further investigation. Originality/value This research is at the forefront, which indicated that the dietary intake of elderly individuals living in the agricultural settlement was inadequate in comparison to the latest recommendation. Strategies to improve their intakes need to be developed and implemented accordingly to improve nutritional status and prevent adverse effects to health.

Maternal and Child Nutrition and Oral Health in Urban Vietnam.

The global nutrition transition has contributed to child obesity and dental caries in developing countries, including Vietnam. Few studies have described the nutrition and oral health of mothers and children. This a descriptive study of the nutrition and oral health characteristics of a convenience sample of 571 children aged 2 to 5 years and their mothers from 5 urban preschools in Central and South Vietnam. The mothers completed a written survey, and the children received dental exams and weight/height measurements. High rates of bottle-feeding and the consumption of sweets were reported. One in 4 children were overweight/obese. Dental caries increased in prevalence and severity by age—at 5 years, 86.7% of children had tooth decay in an average of 8.5 teeth, and 70.9% experienced mouth pain. Most mothers and children suffered from untreated dental disease. Public health programs should focus on nutrition and oral health promotion, as well as dental treatment from pregnancy and birth onward.

Effect of Cassava Starch Coating on the Quality and Shelf Life of Prickly Pear in Refrigerated Storage

In Brazil, the prickly pear has been gaining more and more attention, mainly due to its nutritional health promotion benefits. However, its postharvest conservation is still incipient The aim of this study was to evaluate the use of cassava starch in different concentrations in relation to quality preservation and postharvest shelf life prolongation of prickly pear stored at 10 °C and relative humidity of 95%. Fruit were harvested at maturation stage III, in plants with 8 years of age, in the municipality of Janaúba - MG. Then they were selected, sanitized and immersed in sulutions of cassava starch at 0; 1; 2 and 3% for 1 minute and stored at 10 ± 1 ◦C and relative humidity of 95 ± 5%, for 25 days, and evaluated every five days. The designed trial consisted of a completely randomized trial, in a 4x6 factorial scheme: four concentrations of cassava starch and six periods of evaluations (0, 5, 10, 15, 20 and 25 days), with four replications. Fruit were evaluated for physical, chemical and nutritional characteristics. During storage were observed weight loss, firmness loss, chlorophyll degradation, acidity reduction and ascorbic acid, with increase of soluble solids, total sugars and carotenoids in fruit. The higher the cassava starch concentration, the greater the maintenance of fruit quality. The 3% cassava starch coating was the most efficient at delaying the weight loss, decay, softening and wilting in the fruits, the main characteristics that affect the quality of prickly pear. However, this concentration presented, as an inconvenience, coating peeling at the end of storage.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Comparative Analysis of Vitamin D and Minerals in Normal Children and Children with Short Stature of Busan community child welfare center

Purpose The vitamin D and zinc is important micronutrients but are frequently found deficient in the growth of children in their infancy and adolescence. The present study intend for the analysis of nutritional states and health promotion of short stature children in community child welfare center through an identification of correct measurements of zinc and vitamin D from health examination to be conducted. Methods The children, belonging to the range less than 5 percentiles of anthropometrical height, were diagnosed as short stature children based on the children growth curve in the health examination of community child welfare center. A total of 63 children, who took health examination during from March 2017 to February 2018, were selected as subjects of the present study. The subjects were then distinguished between the short stature group and control group. Measurements of bone age, zinc and vitamin D, obtained from nondominant hand x-ray and peripheral blood collection, were examined and compared to analyze effects of the degree of important minerals over short stature children. Results The mean values of the level of measurements of zinc and vitamin D between subjects belonged to the short stature group and control group manifested no significant differences from each other. The difference in the growth parameter corresponded to the severity of blood serum 25(OH)D also appeared insignificant. Conclusions Unless children are in severe deficiency in zinc and vitamin D, the children subjects belonged to either the short stature group or control group did not exhibit significant difference in growth parameter. This study should be compensated for subsequent studies because of comparatively small number of subjects. Besides, a systematic health management in community child welfare center seems necessary to help growth and development of short stature children. Keywords: Vitmain D, Zinc, Micronutrients, Growth

Design of the Rural LEAP randomized trial: An evaluation of extended-care programs for weight management delivered via group or individual telephone counseling

Obesity is a major contributor to the greater prevalence of chronic disease morbidity and mortality observed in rural versus nonrural areas of the U.S. Nonetheless, little research attention has been given to modifying this important driver of rural/urban disparities in health outcomes. Although lifestyle treatments produce weight reductions of sufficient magnitude to improve health, the existing research is limited with respect to the long-term maintenance of treatment effects and the dissemination of services to underserved populations. Recent studies have demonstrated the feasibility of delivering lifestyle programs through the infrastructure of the U.S. Cooperative Extension Service (CES), which has >2900 offices nationwide and whose mission includes nutrition education and health promotion. In addition, several randomized trials have shown that supplementing lifestyle treatment with extended-care programs consisting of either face-to-face sessions or individual telephone counseling can improve the maintenance of weight loss. However, both options entail relatively high costs that inhibit adoption in rural communities. The delivery of extended care via group-based telephone intervention may represent a promising, cost-effective alternative that is well suited to rural residents who tend to be isolated, have heightened concerns about privacy, and report lower quality of life. The Rural Lifestyle Eating and Activity Program (Rural LEAP) is a randomized trial, conducted via CES offices in rural communities, targeted to adults with obesity (n = 528), and designed to evaluate the effectiveness and cost-effectiveness of extended-care programs delivered via group or individual telephone counseling compared to an education control condition on long-term changes in body weight.

New frontiers in community initiatives to increase vegetable consumption.

Public health concerns about insufficient consumption of vegetables across all demographics in Australia have led to 20years of behaviour change interventions ranging from social marketing to interactive small group programs, with modest results. To maximise health promotion intervention outcomes, practitioners need up-to-date information that helps them navigate the complexity of food systems and eating behaviours. This scoping review of Australian and international research, including peer-reviewed and grey literature, provides a picture of health promotion nutrition interventions, as well as other initiatives that may promote increased vegetable consumption. Search terms related to nutrition and vegetable consumption, type of intervention or initiative, for example, campaign; and consumer values and behaviour. A wide range of data sources were used including scholarly papers, market research reports and publicly available websites of community organisations (eg, OOOOBY). A broad food systems typology was developed to provide a framework for the review. The review finds an emerging group of community-driven initiatives within local food systems that appear to have positive impacts on vegetable consumption. These initiatives sit within a multi-faceted approach to health and well-being that is consistent with the tenets of the Ottawa Charter for Health Promotion, including community engagement, social justice and sustainability goals. More research into the impact of these new frontiers is needed, but our preliminary findings point to the potential for health promotion practitioners to collaborate on local/community food system initiatives that are not motivated primarily by health goals, but have the potential to deliver multiple health and environmental outcomes. SO WHAT?: This review demonstrated community-driven initiatives around local food systems show the most promise in promoting vegetable consumption and addressing the determinants of health. Health promotion efforts to encourage food security and healthy eating could be strengthened through collaborations within these new frontiers.

Cooking Up Health: A Novel Culinary Medicine and Service Learning Elective for Health Professional Students.

The current investigation assessed the feasibility, acceptability, and efficacy of the Cooking Up Health (CUH) culinary medicine elective that was offered to medical students at Northwestern University's Feinberg School of Medicine. The elective included a combination of didactics, plant-based culinary sessions, and service learning, in which students translated nutrition and health connections to elementary school children in at-risk communities. Nine medical students enrolled in cohort 1 and 12 in cohort 2. Students completed assessments before and after the course measuring confidence in nutrition and obesity counseling, attitudes toward nutrition counseling, personal dietary intake, and cooking confidence and behaviors. The elective showed high feasibility and acceptability with strong class attendance (96%-99%) and retention (89%-100%). Over the course of the elective, students across both cohorts showed increased confidence in nutrition and obesity counseling (ps < 0.001), cooking abilities (ps < 0.01), and food preparation practices (ps < 0.04). Cohort 1 reported decreased meat consumption (p = 0.045), and cohort 2 showed increased fruit and vegetable intake (p = 0.04). Finally, cohort 2 showed increased knowledge and confidence regarding consuming a plant-based diet (ps < 0.002). Students reported an increased appreciation for the role of nutrition in health promotion and disease prevention and an intention to incorporate nutrition into patient care. This study provided preliminary evidence demonstrating feasibility, acceptability, and efficacy of the CUH culinary medicine elective for increasing medical students' confidence in nutrition and obesity counseling of patients and in their ability to use nutrition and cooking for personal self-care. Ultimately, this program of research may provide evidence to support widespread integration of CUH into medical education and has the potential to prepare medical students to properly advise patients on nutrition to combat the rising rates of obesity, diabetes, and preventable diseases related to nutrition.

In their own words: A qualitative study exploring influences on the food choices of university students.

University students generally make independent decisions regarding food choices. Current research about knowledge of Australian Dietary Guidelines (ADG), sources of nutrition information and influences on food choices for this group is scarce. Qualitative data were collected from gender-separated focus groups comprising four female (n = 31) and four male (n = 18) to identify: knowledge of ADG; sources of nutrition information; factors that influence food choices; perceived relevant nutrition messages and how best to deliver them. Gaps in knowledge were identified particularly regarding number of serves and serving size for food groups. Social media was the most commonly reported source of knowledge. Social media was also a major influence on food choice due to its impact on body ideals. Current health promotion nutrition messages were perceived irrelevant given the focus on long-term health risks. Health and adhering to the ADG were not identified as important. The desire to look a particular way was the major influence on food choices. SO WHAT?: While there is an awareness of ADG, our participants made a deliberate decision not to follow them. This provides a challenge for developing relevant preventive health messages for this target audience.

Global burden of obesity

Global burden of obesity Introduction The burden of nutritional disorders is increasing despite advances in scientific research and health promotion. Nutritional disorders include excess body mass conditions especially obesity (body mass index [BMI] &gt; 30 kg/m2) and being overweight (BMI &gt; 25 and &lt; 30 kg/m2). These conditions are now considered as precursors to several diseases including diabetes, heart disease, musculoskeletal disorders as well as psychiatric illnesses. We studied the global burden of obesity to assess temporal trends and regional variations of this highly prevalent nutritional disorder. Methods We used the Global Burden of Disease database from the Institute of Health Metrics (www.healthdata.org) at the University of Washington, Seattle. This database collates data from a very large number of studies and census figures to generate regional estimates for health statistics. We analyzed the data from 1990 to 2015 using global averages for years lived with disability (YLD). The primary risk factor analyzed was ‘High body-mass index’. The effect of high BMI on all causes of health reduction (including diabetes) were studied for temporal (1990 to 2015) and regional/national patterns. Results The global of burden of diseases due to high BMI is rising continuously, from 213 YLDs per 100,000 in 1990 to 388 YLDs in 2015. A high burden of YLDs was seen in developed regions including North America and Australasia. Northern Europe and Middle East were also disproportionately affected. Areas with low rates of YLDs from obesity included sub-Saharan Africa, south Asia and south east Asia. Marked increases in the rates per 100,000 populations were seen over 1990 to 2015 in countries such as Fiji, USA, Egypt and Ukraine. The burden of suffering is higher among women than men. Conclusion The global burden of suffering due to illnesses caused by high body mass index is continuing to rise. Existing public health measures appear to be ineffective and more efficacious nutritional education and health promotion strategies are urgently needed. Conflicts of interest disclosure: no external or commercial funding source, and no holding of significant equity in a company relevant to the study.

Evaluation of nutritional care of overweight adults from the perspective of comprehensive health care

ABSTRACT Objective: Describe and evaluate the nutritional care provided for overweight adults by the Primary and Secondary Health Care services of Santos, São Paulo, Brazil. Methods: This study was carried out between 2013 and 2015 integrating quantitative and qualitative approaches; it was divided into two phases: (1) characterization and (2) evaluation. In phase 1, a census of Primary Health Care Units (n=28) and Secondary Health Care Units (n=4) was conducted using interviews with health service managers and/or health professionals. Data were analyzed using exploratory data analysis. In phase 2, in-depth interviews were conducted with health service managers and/or health professionals investigating a sample of the Primary Health Care services and the totality of Secondary Health Care services provided. Thematic analysis was carried out using the theoretical framework for comprehensive health care proposed by Pinheiro &amp; Mattos. Results: A total of 40 professionals were interviewed: 36 in the primary health care services and 4 in the secondary health care services. Nutritional care in the Primary Care services is focused on individual care and referrals to other services; nutrition diagnosis and health promotion occur only when overweight is associated with another disease. It was observed that the referral and counter-referral system and intersectorial collaborations were ineffective. In Secondary Care services, nutritional care is focused on clinical care using traditional approaches to nutrition education. Limiting factors for promoting comprehensive care were identified at the two levels of care: unproductive actions, lack of actions for health promotion and protection, and little dialogue between the Primary and Secondary care services. Conclusion: Overweight is not an outcome based on Primary and Secondary Care, but rather on prescriptive practices, which are not very effective in promoting users’ autonomy. It is necessary to guide the actions taken in these two levels of care to ensure the promotion of effective nutritional care.

Educação nutricional em universitários e estratégias para promoção de saúde institucional: revisão integrativa

Objective: To reflect on the university environment as a nutritional health promoting space with a focus on the strategies used. Methods: An integrative review of articles published in SCOPUS, MEDLINE (PubMed), LILACS and SciELO databases under the following descriptors: Nutrition Education, University Students, College Students, and Health Promotion. The review included original studies published between 2010 and 2015 in Portuguese, English or Spanish that reported a nutritional intervention strategy carried out with well-defined population of university students. Only 18 articles out of the 649 studies reviewed were included after the analysis of titles, abstracts and full text. All the studies were conducted outside Brazil. Results: The university environment was found to be a potential health promoting space in the international context that is still incipient in the national context. Positive changes in dietary behaviors were reported, although there were no long-term assessments. The main strategies identified were practical and theoretical interventions based on the social cognitive theory and motivation theory. Conclusion: The university environment has great potential for the promotion of nutritional health and the most effective strategies were those based on the social cognitive theory. However, this environment has been little explored in the national context. Changing this reality requires the redefinition of the strategies used and of the public policies and intersectoral actions that support such a practice so that it can be inserted in the social identity of higher education in Brazil.

Canadian Nutrient File (CNF): Update on Canadian food composition activities

A new update of Canada’s food composition database, the Canadian Nutrient File (CNF) 2015, is now available on our website at www.healthcanada.gc.ca/cnf. Users will find updates to many food categories, as well as additions to better reflect the continually changing food market. For 12 updated food categories, the nutrient profiles were obtained through our relatively new Sampling and Nutrient Analysis program for sample collection and analysis of Canadian food samples. Depending on the nature of the food market for a given category, the method approach to developing a sampling plan can vary. The approaches developed are outlined in this paper. The goal of CNF sampling is to provide generic food profiles that are representative of at least 85% of the market presented to the Canadian consumer. The updated nutrient data are being used to calculate nutrient intakes from the 2015 Canadian national nutrition survey, as well as inform a multitude of nutrition studies, policies and health promotion activities in Canada.

Community perspectives on the use of regulation and law for obesity prevention in children: A citizens’ jury

IntroductionChildhood obesity is a significant challenge for public health internationally. Regulatory and fiscal measures propagated by governments offer a potentially effective response to this issue. Fearing public criticism, governments are often reluctant to use such measures. In this study we asked a descriptively representative and informed group of Australians their views on the use of legislation and fiscal measures by governments to address childhood obesity. MethodsA citizens’ jury, held in South Australia in April 2015, was asked to consider the question: What laws, if any, should we have in Australia to address childhood obesity? ResultsThe jury agreed that prevention of obesity was complex requiring multifaceted government intervention. Recommendations fell into the areas of health promotion and education (n=4), regulation of food marketing (n=3), taxation/subsidies (n=2) and a parliamentary enquiry. School-based nutrition education and health promotion and mandatory front-of-pack interpretive labelling of food and drink were ranked 1 and 2 with taxation of high fat, high sugar food and drink third. ConclusionThe recommendations were similar to findings from other citizens’ juries held in Australia suggesting that the reticence of decision makers in Australia, and potentially elsewhere, to use legislative and fiscal measures to address childhood obesity is misguided. Supporting relevant informed public discussion could facilitate a politically acceptable legislative approach.