Nutrition Program Research Articles

Abstract P473: WIC-Tailored, Pre-Filled Online Shopping Carts Influence WIC Food Benefit Redemption

Introduction: Most participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their benefits, due to barriers like transportation, unclear labeling, and category-specific limits. Online food shopping enables the use of choice architecture to promote benefit redemption. Using a mixed-methods pilot randomized-controlled trial, we evaluated whether a WIC-tailored, modifiable pre-filled online grocery shopping cart (intervention group, I) compared to individually selecting items (control group, C) increased WIC benefit redemption. Hypothesis: The I vs. C will have higher change in benefit redemption. Methods: We enrolled Rhode Island WIC participants (n=24) who were ≥18 years and primary food shoppers, spoke English or Spanish, had internet, and no special dietary needs. At baseline, participants completed a sociodemographic questionnaire and a simulated shopping episode (SSE) conducted in Gorilla Shop Builder. They were told to shop as if using all monthly food benefits and to buy WIC and non-WIC items to last 10 days. After a week, we randomized participants to the I or C to complete the second SSE. The I had a modifiable cart pre-filled with WIC items providing 100% of the benefits proposed on the 2022 food package revision, except for fruits/vegetables (33%) and milk (25%) and was personalized with items selected in the first SSE. The C selected their items individually. Both groups had a list of their assigned benefits, and WIC labels for approved items. WIC benefit redemption was expressed as % of the maximum allotted amounts for each food group, per person. Between-group t-tests examined differences in redemption rates. Results: Women were primarily Hispanic (75%), White (50%), postpartum (63%), and had never shopped online (54%). Redemption increased up to 65% more in the I vs. the C for most WIC categories. Conclusions: Results from this pilot trial suggest that a WIC-tailored, pre-filled online shopping cart may be a promising tool to improve WIC benefit redemption.

Linkages between maternal experience of intimate partner violence and child nutrition outcomes: A rapid evidence assessment.

A strong evidence base indicates that maternal caregivers' experience of intimate partner violence [IPV] impacts children's health, cognitive development, and risk-taking behaviors. Our objective was to review peer-reviewed literature describing the associations between a child's indirect exposure to IPV and corresponding nutrition outcomes, with a particular focus on fragile settings in low and middle-income countries [LMICs]. We conducted a rapid evidence assessment to synthesize quantitative associations between maternal caregivers' IPV experience and children's nutrition/growth outcomes (birthweight, feeding, and growth indicators). We included peer-reviewed research, published in English or Spanish after the year 2000, conducted in fragile settings in LMICs. We identified 86 publications that fit inclusion criteria. Amongst all associations assessed, a maternal caregiver's experience of combined forms of IPV (physical, sexual and emotional) or physical IPV only, were most consistently associated with lower birthweight, especially during pregnancy. Women of child-bearing age, including adolescents, exposed to at least one type of IPV showed a decreased likelihood of following recommended breastfeeding practices. Lifetime maternal experience of combined IPV was significantly associated with stunting among children under 5 years of age in the largest study included, though findings in smaller studies were inconsistent. Maternal experience of physical or combined IPV were inconsistently associated with underweight or wasting in the first five years. Maternal experience of sexual IPV during pregnancy appeared to predict worsened lipid profiles among children. Maternal caregivers' experience of IPV is significantly associated with low birthweight and suboptimal breastfeeding practices, whereas studies showed inconsistent associations with child growth indicators or blood nutrient levels. Future research should focus on outcomes in children aged 2 years and older, investigation of feeding practices beyond breastfeeding, and examination of risk during time periods physiologically relevant to the outcomes. Programmatic implications include incorporation of GBV considerations into nutrition policies and programming and integrating GBV prevention and response into mother and child health and nutrition interventions in LMIC contexts.

Barriers and Enablers to a Hospital-to-Home, Combined Exercise and Nutrition, Self-Managed Program for Pre-Frail and Frail Hospitalised Older Adults.

Self-managed exercise and nutrition interventions can alleviate pre-frailty and frailty but understanding of adherence to them is lacking. This study aimed to explore the experiences of, and barriers and enablers to, a hospital-to-home self-managed combined exercise and nutrition program for hospitalised older adults living with pre-frailty and frailty. A hybrid approach to data- and theory-driven descriptive thematic analysis identified experiences, barriers, and enablers to participation in a 3-month, self-managed, exercise-nutrition, hospital-to-home frailty-support program. Pre-frail and frail older adult patients ≥ 65 years admitted to the acute medical unit at a South Australian tertiary hospital were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim, and analysed descriptively, using the Theoretical Domains Framework. The nutrition component of the program found 11 common barriers and 18 common enablers. The exercise component included 14 barriers and 24 enablers. Intentions, Social influences, Environmental context/resource and Emotions served as primary barriers towards adherence to both components. Common enablers for both components included Knowledge, Social identity, Environmental context/resource, Social influences, and Emotions. This research revealed important factors affecting adherence to a self-managed exercise-nutrition program in pre-frail and frail older adults within the environment, resources, and emotion domains that should be considered when designing other intervention programs in this population group.

Understanding differential reductions in undernutrition among districts in Rwanda through the perspectives of mid-level and community actors on policy commitment and policy coherence.

Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi-structured interviews with mid-level actors (n = 38) and frontline workers (n = 20) implementing Rwanda's multi-sectoral nutrition policy in five districts in which stunting decreased (reduced districts) and five where it increased or stagnated (non-reduced districts) based on Rwanda's 2010 and 2014/15 Demographic and Health Surveys. Mid-level actors are government officials and service providers at thesubnational level who represent the frontline of government policy. Interviews focused on political commitment to and policy coherence in nutrition, and contributors to nutrition changes. Responses were coded to capture themes on the changes and challenges of these topics and compared between reduced and non-reduced districts. Descriptive statistics described district characteristics. Political commitment to nutrition was high in both reduced and non-reduced districts. Respondents from reduced districts were more likely to define commitment to nutrition as an optimal implementation of policy, whereas those from non-reduced districts focused more on financial commitment. Regarding coherence, respondents from reduced compared to non-reduced districts were more likely to report the optimal implementation of multi-sectoral nutrition planning meetings, using data to assess plans and progress in nutrition outcomes and integration of nutrition into the agriculture sector. In contrast, respondents from non-reduced districts more often reported challenges in their relationships with national-level stakeholders and nutrition and/or monitoring and evaluation capacities. Enhancing the integration of nutrition in different sectors and improving mid-level actors' capacity to plan and advocate for nutrition programming may contribute to reductions in stunting.

The Relationship between Chronic Energy Deficiency and the Incidence of Anemia in Female Adolescent in Stunting Locus Areas

Background: Adolescent girls are a group that is prone to anemia, so they are at risk of giving birth to stunted children. This study aims to analyze the factors most associated with the incidence of anemia in adolescent girls in the stunting locus area. Subjects and Method: This was a cross sectional study conducted in Patokaan Village, North Minahasa Regency, North Sulawesi. A total of 50 adolescent girls were selected in this study. The dependent variable was anemia. The independent variables were nutritional status, Chronic Energy Deficiency (CED), nutrient intake (Fe, protein, vitamin C), body perception (Body Image), nutritional knowledge, and menstrual patterns based. The variables studied were anemia based on laboratory examination, nutritional status according to BMI/A and CED using anthropometric methods, nutrient intake (Fe, protein, vitamin C) using 24-hour recall, body perception (Body Image), nutritional knowledge, and menstrual patterns based on questionnaire interviews. Fisher's Exact Test was used for bivariate analysis and logistic regression for multivariate analysis. Results: Adolescent girls with CED have a 5.21 times risk of experiencing anemia compared to those without CED, and this result was statistically significant (aOR= 5.21; 95% CI= 1.01 to 26.83; p = 0.048). Conclusion: CED is associate with anemia in adolescent girls in the stunting locus area. This study is expected to be useful for the North Minahasa District Health Office as input for policy makers, planning, and implementing public health nutrition programs. Keywords: anemia, chronic energy deficiency, adolescent girls. Correspondence:Nancy S. H. Malonda. Study Program of Public Health, Faculty of Public Health, University of Sam Ratulangi, Manado, Indonesia. Email: nancymalonda@unsrat.ac.id.

Information Seeking Behavior and Strategies to Increase Milk Supply Among Breastfeeding Mothers in the United States.

Background: Some breastfeeding mothers try to increase their milk supply through pharmaceutical, dietary, and behavioral strategies that vary in effectiveness. Information seeking behaviors may influence which strategies mothers use. Objective: To describe where mothers obtain information about increasing milk supply, describe the perceived influence of each information source on decision-making about strategies for increasing milk supply, and explore associations between information sources and mothers' use of galactagogues (i.e., pharmaceutical and dietary strategies) and behavioral strategies. Methods: Women who were currently breastfeeding and living in the United States were recruited through Facebook advertisements to complete an online survey between December 2020 and February 2021. Descriptive statistics were calculated, and chi-square tests compared participants' use of galactagogues and behavioral strategies by information sources. Results: Participants were 1,351 breastfeeding mothers (81% non-Hispanic white; 47% first-time breastfeeding; 21% Special Supplemental Nutrition Program for Women, Infants, and Children participants). Nearly all participants (97%) obtained information about increasing milk supply from at least one source, most commonly lactation consultants (68%), Facebook (61%), search engines (50%), websites (47%), and nurses (41%). There was high variability in the perceived influence of each source on decision-making. Galactagogue use was higher among participants who obtained information from the internet (Yes: 68% vs. No: 43%, p < 0.000), social media (Yes: 65% vs. No: 40%, p < 0.000), family and friends (Yes: 65% vs. No: 53%, p < 0.000), and lactation consultants (Yes: 63% vs. No: 54%, p < 0.002). Behavioral strategies were more commonly reported among participants who accessed these same sources, maternal health care professionals (Yes: 98% vs. No: 91%, p < 0.000), and pediatricians (Yes: 98% vs. No: 94%, p = 0.001). Conclusion: Breastfeeding mothers commonly obtained information about increasing milk supply from a variety of sources. Information sources accessed were associated with mothers' use of galactagogues and behavioral strategies for increasing milk supply.

Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): study protocol for a five-arm, cluster-randomized trial

BackgroundGlobally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers.MethodsEngaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers’ groups, with or without fathers’ groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers’ and fathers’ groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers’ groups receiving a nutrition program, (2) mothers’ groups receiving a bundled nutrition and parenting program, (3) mothers’ and fathers’ groups receiving a nutrition program, (4) mothers’ and fathers’ groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention).DiscussionEFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes.Trial registrationClinicalTrials.gov NCT03759821. Registered on November 30, 2018

Early nutritional programming in sterlet sturgeon (Acipenser ruthenus) with dietary soybean meal: Assessment of growth performance, body composition, and expression of GH, IGF-I, and Ghrelin genes.

This study was performed to assess the impacts of introducing diets containing different levels of soybean meal (SBM) to sterlet sturgeon (Acipenser ruthenus) larvae on growth performance, body composition, and molecular responses in the juvenile stage. The sterlet larvae (57.68 ± 0.66 mg) were weaned onto the formulated diets as follows: a control diet containing 60% fishmeal (FM), and three experimental diets with replacement levels of 15% (SBM15), 30% (SBM30), and 45% (SBM45) of FM with SBM. Then, a total of 260 fish (initial weight: 323.33 ± 11.76 mg) were fed the four different diets for 28 days in triplicates (phase 1, nutritional programming, NP). All treatments were then fed with the FM diet in phase 2 (common phase), and in phase 3 (challenge phase), all experimental groups (6.14 ± 0.08 g) were transitioned to SBM45 for 28 days. At the end of phases 1 and 2, growth performance showed no significant differences among the groups (P > 0.05), while significantly improved in SBM45 than the control at the end of phase 3 (P < 0.05). No significant differences were found among the groups in any phases for whole body composition (P > 0.05). Additionally, the total saturated fatty acids were significantly higher in SBM-based diets than FM at the end of phase 3 (P < 0.05). The mRNA of GH, IGF-I was significantly affected by variation of FM replacement level (P < 0.05). The expression level of Ghrelin was up-regulated in fish fed SBM at the end of phase 3 (P < 0.05). Our findings revealed that NP can positively enhance the adaptation of juvenile sterlet sturgeon to 45% SBM when exposed to the same diets at the larval stage. Further research is being carried out to provide valuable insights into the underlying mechanisms of digestive performance for this species.

Awareness and Support of Responsive Bottle Feeding Among WIC Counselors and Caregivers: A Formative Qualitative Study

To understand the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counselor experiences discussing responsive bottle feeding during counseling and WIC participants' knowledge, understanding, and use of responsive bottle feeding. Qualitative descriptive, semistructured interviews with 23 participants (8 WIC counselors and 15 WIC participants) were conducted online via Zoom. The WIC counselors and mothers of WIC-enrolled bottle-fed infants were recruited through a network of WIC clinics in North Carolina. Interviews were recorded, transcribed, and collaboratively analyzed using content analysis. The WIC participants received responsive infant feeding support from WIC counselors but often in the context of breastfeeding. WIC counselors provided valuable support for families but were challenged by limited training on responsive bottle feeding, balancing promoting breastfeeding with supporting mothers' feeding decisions, and time constraints. Findings provide preliminary support for the need to develop and pilot an intervention focused on promoting responsive feeding for parents of bottle-fed infants.

Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study

BackgroundWhile vegetable intakes in Australia remain sub-optimal across all age groups, children are rarely consulted about their ideas on how to increase consumption. Qualitative research involving children provides an opportunity to consider their views. The aim of the Kids initiative inspires Dietary Success in Adults and Youth (KiiDSAY) project was to explore the views of school-aged children, who had participated in a school-based nutrition education program, about inspiring their peers and families to eat more vegetables.MethodsA total of 26 children (15 boys) aged 10–12 years from four primary schools in New South Wales, Australia, participated in seven focus group interviews. Purposeful sampling was used to recruit participants. The study involved open-ended semi-structured questions conducted via Zoom that were audio-recorded, transcribed verbatim and analysed using thematic analysis with deductive and inductive coding in NVivo.ResultsFour major themes emerged: (i) taste; (ii) family environment; (iii) healthy eating; and (iv) change makers; with subthemes that were embedded within Social Cognitive Theory and Ecological Model of Health Behaviour theoretical frameworks.ConclusionsChildren’s inputs hold great potential for informing future interventions, particularly when designing or refining school-based nutrition programs. Children offered suggestions on how to inspire increased vegetable consumption among their peers and families that could be taken into consideration for future research and practice. These included: cooking activities in the home and school settings using recipes that creatively hide/mask/enhance the flavour of vegetables, involving positive role models and supportive school environments. Additionally, children recommended a sequential approach to the delivery of recipes starting from fruit-based and transitioning to vegetable-based recipes. Given the challenges faced in increasing children’s vegetable consumption, particular focus on future research in this area is warranted.Trial registrationFEAST Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954).

Efforts Undertaken by Several ASEAN Countries to Address Childhood and Adolescent Obesity in School-Based Programs: A Systematic Review

Background: Childhood and adolescent obesity is on the rise in Southeast Asia. Necessitating stronger actions from ASEAN governments to address this issue, because the significant financial and social welfare implications. Schools provide an effective platform for targeted interventions among children and adolescent groups. Objectives: This study provides an overview of school-based nutrition interventions implemented in ASEAN countries to address childhood and adolescent obesity. Methods: A literature review was conducted by searching multiple databases (Google Scholar, PubMed, ProQuest, ScienceDirect, and Web of Science) between April 1 and May 1, 2023. The search included computer-based searches and manual search in relevant journals. The articles considered were limited to publications from the past 10 years. Discussion: School-based nutrition interventions in ASEAN countries require further development, with attention to key factors such as intervention duration, sample size, and family involvement. Conclusions: Urgent large-scale research is needed to evaluate the effectiveness of existing school-based nutrition programs. Integrated and effective programs require support and collaboration from families, the private sector, and the government.

A Qualitative Exploration of Spanish-Speaking Latina Women’s Experiences Participating in WIC Before and During the COVID-19 Pandemic

BackgroundMore than one-third of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants identify as Latino, but participation has been declining and individuals who speak predominantly Spanish face additional barriers to participation. During the COVID-19 pandemic, there were changes in WIC eligibility and benefits that may have been differentially accessible to Spanish-speaking Latina participants due to factors such as language barriers and lack of awareness of changes. Understanding Spanish-speaking Latinas’ experiences with the WIC program generally and during the pandemic can inform efforts to equitably implement future emergency food response policies and improve the WIC program and Latina participant enrollment more broadly. ObjectiveThis study aimed to understand the perceptions and experiences of Spanish-speaking Latina WIC participants with the WIC program generally and with COVID-19 pandemic–related policy changes made to the WIC program. DesignQualitative in-depth interviews were conducted virtually in Spanish in August 2022 using a semi-structured guide. Participants/settingStudy participants were 18 Spanish-speaking Latina adult WIC participants living in North Carolina recruited using convenience sampling. AnalysisAll interviews were recorded, transcribed, and coded in Spanish. Thematic analysis with inductive coding was used to derive key themes. ResultsPerceptions about the WIC program in this sample were mixed. Participants felt positively about the healthfulness of foods included in the WIC food packages but expressed concern about the monthly benefit amounts being too low and the cultural appropriateness of food options. Pandemic policy changes, such as remote appointments and the Cash Value Benefit increase were perceived positively; however, barriers to using benefits during this time included limited communication from WIC agencies, food shortages, and concerns about not being granted US citizenship or permanent resident status due to use of WIC (ie, public charge rule). Social networks played an important role in learning about and enrolling in WIC and navigating food shortages during the pandemic. ConclusionsConcerns about the cultural appropriateness of foods provided, communication challenges, and the public charge rule emphasized the need for resources dedicated in the WIC program to improving Spanish-speaking Latina women’s experiences with WIC.

Analysis of missed clinic visits, preferred languages, and telemedicine in a pediatric gastroenterology practice.

Previous studies have demonstrated a relationship between socioeconomic disparities and missed clinic visits (MCV). However, the relationship between patient-preferred language and MCVs, particularly with respect to telemedicine, remains relatively underexplored. We sought to characterize the associations between MCV and patient-level predictors, including preferred language, in a large single-center pediatric gastroenterology, hepatology, and nutrition practice. This retrospective longitudinal cohort study included all missed or completed outpatient visits in the Gastroenterology, Hepatology, and Nutrition Programs at Boston Children's Hospital from January 1, 2016to May 20, 2022. Univariate and multivariate hierarchical generalized linear mixed models were employed to identify associations between visit- and patient-level predictors and an MCV outcome. A total of 300,201 visits from 70,710 patients residing in Massachusetts were included. Univariate analyses revealed higher MCV odds for Hispanic patients and those from areas with the highest Social Vulnerability Index (SVI), and these odds increased with telemedicine (Hispanic in-person odds ratio [OR] 5.21 [(95% confidence interval) 4.93-5.52] vs. telemedicine OR 8.79 [7.85-9.83]; highest SVI in-person OR 5.28 [4.95-5.64] vs. telemedicine OR 7.82 [6.84-8.96]). Controlled multivariate analyses revealed that among six language groups, only Spanish language preference was associated with higher MCV odds, which increased with telemedicine (Spanish in-person adjusted OR [aOR]1.35 [1.24-1.48] vs. telemedicine aOR 2.1 [1.83-2.44]). Patients preferring Spanish experience unique barriers to care beyond those faced by other language preference groups, and telemedicine may exacerbate these barriers.

Evaluation of pre- and postoperative nutrition and oral health–related quality of life in orthognathic surgery patients

ObjectiveOrthognathic surgery is a complex orofacial surgery that can significantly impact occlusal function and effect nutritional and quality of life parameters. This study aimed to evaluate alterations in dietary intake, chewing function, physical activity, and oral health–related quality of life of patients undergoing orthognathic surgery. Research Methods and ProceduresIn this prospective longitudinal study, the assessments were conducted at: preoperatively (T0) and postoperative first week (T1), second week (T2), first month (T3), and third month (T4) between May 2021 and March 2023. Sociodemographic questionnaire, 24-h dietary recall record, chewing ability form, International Physical Activity Questionnaire, and Oral Health Impact Profile-14 (OHIP-14) was applied at face-to-face interviews. ResultsSeventy eligible orthognathic surgery patients were evaluated, and 37 patients (52.8%) completed this study. Energy and fat intake significantly decreased from T0 to T1 (P < 0.001) and returned to basis by T4 (P = 0.015). Fiber intake was found to be lowest at T1 and T2 compared with other time points (P < 0.001). Chewing ability showed a deterioration and then improvement; however, patients still had difficulties chewing hard foods at T4. The OHIP-14 increased at T2 and T3 from T0 (P < 0.001 and P = 0.021, respectively) and showed a significant improvement at T4 (P < 0.05). ConclusionThe findings indicate a temporary decline in nutritional intake and chewing ability with subsequent recovery by the third month postsurgery. These changes, along with the trends in oral health-related quality of life, underscore the need for tailored nutritional and functional rehabilitation programs following orthognathic surgery.

Strategi Intervensi Penanganan Stunting di Indonesia: Studi Literatur

Stunting not only has an impact on children's physical growth and development, but also has significant long-term implications for the quality of Indonesia's human resources (HR) in the future. Comprehensive and multi-sectoral stunting management efforts involving various parties need to be carried out. To analyze more deeply the intervention strategies that have been implemented in efforts to deal with stunting in Indonesia as a form of identifying approaches that have been proven successful and are relevant for the Indonesian context. This research uses the PRISMA literature review, through a digital library database that is connected to various scientific publication pages through keywords such as "Stunting", "Stunting Intervention", "Stunting Strategy", and "Stunting Program". Eligibility criteria use various types of methods The research includes quantitative, qualitative methods and reviews related to intervention strategies for handling stunting in Indonesia. Intervention strategies for handling stunting in Indonesia include three groups of programs, namely age-specific nutrition programs, nutrition and reproductive health education as well as strengthening posyandu and community health centers. Strategies Stunting prevention interventions in Indonesia must involve all stakeholders, prioritize preventive approaches, and encourage changes in community behavior. By strengthening government commitment and innovative cross-sector collaboration, it is hoped that Indonesia can overcome the challenge of stunting in a sustainable manner.

School nutritious feeding and cognitive abilities of students in poverty: Evidence from the nutrition improvement program in China

While considerable attention has been paid to the benefits of school nutritious feeding, little literature focused on the effect on human capital accumulation for students in poverty. By drawing on the quasi-natural experiment of the Nutrition Improvement Program (NIP) and adopting the Difference-in-Differences (DID) method, we sought to determine the causal relationship between school nutritious feeding and the cognitive ability (CA) development among poor students in China. Specifically, our estimates confirmed that NIP implementations significantly improved the CAs of students in poverty, which is supported by several robustness checks. Moreover, the potential mechanisms of this positive effect included improved health status, enhanced sense of belonging at school, and increased positive expectations for the future. Our study further enriches the literature on the positive effects of school nutritious feeding and provides insights for developing countries to customize nutritional poverty alleviation programs to promote human capital development.

34 A survey of the Oklahoma State University Cowculator user preferences

Abstract The Oklahoma State University Cowculator is a free, easy to use model designed to assist cattle producers in making informed decisions regarding the nutrition of their herd. The Cowculator operates as a spreadsheet-based model, which collects information from the 2016 National Academy of Science, Engineering, and Medicine’s Nutrient Requirements for Beef Cattle, previous editions of the book, and previous research data. Producers have the option to adjust animal characteristics, feed and forage values, and diet composition to fit certain production objectives. In 2022, a Qualtrics survey was developed to determine perception of users of the program and their likes and dislikes. When users download the program, they are required to enter their name, email address, and zip code. A link to the survey was emailed to each address registered within the Cowculator database, with an email reminder sent out 30 days later. The survey yielded 233 responses. According to user download data, in 2022 the Cowculator was downloaded 2,090 times from 41 states and 53 countries. Based on email addresses ending in “.edu” the program was downloaded by faculty or students from 135 different universities, colleges, or other technical institutions. Of the respondents, 60% identified as beef cattle producers, 16% as industry professionals (e.g., consultants, veterinarians), 11% as extension personnel, 7% as research or teaching faculty, and 6% as students. Regarding the type of enterprise which the program was used for, 52% responded with cow/calf, 33% growing or stocker cattle, and 15% finishing cattle. The survey indicated that 88% of respondents were able to utilize the program effectively to evaluate or modify their nutrition program, while 16% indicated they were not successful in using the program. The survey asked respondents to give their opinion on the accuracy of the program. 69% indicated that it yielded “mostly accurate” projections, 23% responded with “very accurate”, and 5% perceived the program to be inaccurate or marginally accurate. Users of the program estimated the average annual benefit of the program to be $1,500. The respondents were asked to select what they liked about the program and what they felt needed improvement. It was indicated that the most liked features were that the program was free and that it was easy to use. The features that were indicated as needing improvement where the limited pre-added list of feedstuffs and the lack of availability of a simplified app version of the program. The results of this survey provide valuable insights regarding user demographics, as well as what can further be adjusted within the Cowculator to best fit the needs of the users.

Nutritional Status Link with Polioseronegativity Among Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC).

Malnutrition is identified as a risk-factor for insufficient polioseroconversion in the context of a vaccine-derived polio virus (VDPV) outbreak prone region. To assess the prevalence of malnutrition and its link to poliovirus insufficient immunity, a cross-sectional household survey was conducted in the regions of Haut- Lomami and Tanganyika, DRC. In March 2018, we included 968 healthy children aged 6 to 59 months from eight out of 27 districts. Selection of study locations within these districts was done using a stratified random sampling method, where villages were chosen based on habitat characteristics identified from satellite images. Consent was obtained verbally in the preferred language of the participant (French or Swahili) by interviewers who received specific training for this task. Furthermore, participants contributed a dried blood spot sample, collected via finger prick. To assess malnutrition, we measured height and weight, applying WHO criteria to determine rates of underweight, wasting, and stunting. The assessment of immunity to poliovirus types 1, 2, and 3 through the detection of neutralizing antibodies was carried out at the CDC in Atlanta, USA. Of the study population, we found 24.7% underweight, 54.8% stunted, and 15.4% wasted. With IC95%, underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.96; [1.52-2.54]) were significantly associated with seronegativity to polioserotype 1. Underweight (OR=1.64; [1.20-2.24]) and the non-administration of vitamin A (OR=1.55; [1.20-2.01]) were significantly associated with seronegativity to polioserotype 2. Underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.80. [1.38-2.35]) were significantly associated with seronegativity to polioserotype 3. Underweight (OR=1.68; IC95% [1.10-2.57]) and the non-administration of vitamin A (OR=1.82; IC95% [1.30-2.55]) were significantly associated with seronegativity to all polioserotypes. This study reveals a significant association between underweight and polioseronegativity in children. In order to reduce vaccine failures in high-risk areas, an integrated approach by vaccination and nutrition programs should be adopted.

Analysis of Dietary and Nutritional Status of Tuberculosis Patients in Hulunbuir Region.

Tuberculosis (TB) is a major public health problem that affects millions of people worldwide. Malnutrition is a common complication of TB and can worsen the disease outcome. The purpose of this study was to investigate the dietary and nutritional status, as well as the dietary structure, of TB patients in Hulunbuir City, Inner Mongolia, China. Additionally, the study aimed to analyze the factors that influence the nutritional status in order to provide a theoretical foundation for the prevention and treatment of TB and related issues. A cross-sectional study was conducted on 334 randomly selected TB patients from Hulunbuir City Second Hospital. A questionnaire survey was administered to collect information on demographic characteristics, dietary habits, and food intake. Nutritional status was assessed by body mass index (BMI). Dietary diversity score (DDS) was calculated based on the number of food groups consumed in the previous 24 hours. Statistical analysis was performed using SPSS 20.0 software. Descriptive statistics employed rates and composition ratios, and categorical data was represented using frequencies and percentages. The chi-square test was used to analyze the association between nutritional status and other variables, with a significance level set at α=0.05. Multivariable ordinal logistic regression analysis was performed to identify the independent factors affecting the nutritional status of TB patients. The univariate analysis revealed statistically significant differences (P < 0.05) in the nutritional status (as measured by BMI) among tuberculosis patients, considering ethnicity, educational level, smoking, meat-based diet, vegetable consumption, and DDS grading. No statistically significant differences were found regarding gender, age, marital status, occupation, sleep duration, alcohol consumption, and consumption of rice and flour dishes. Statistically significant variables from the univariate analysis were included in a multivariable ordinal logistic regression analysis model. The findings highlighted that educational level (high school or below), smoking, meat-based diet, DDS scores of 1-3, and a primarily vegetable-based diet had independent effects on the nutritional status of tuberculosis patients (all P < 0.05). No significant difference was found in nutritional status between the Han ethnic group and other ethnicities. The study revealed that the dietary and nutritional status of TB patients in Hulunbuir City was suboptimal and influenced by several factors. Smoking, meat-based diet, and low dietary diversity score were the primary risk factors for malnutrition among TB patients. The study suggests that nutritional education and intervention programs should be implemented for TB patients to improve their dietary quality and nutritional status.

Advancing Healthy Lifestyles:: A Multicomponent Initiative to Reduce the Burden of Obesity In Delaware.

Chronic Disease, Health Equity, & COVID-19 ("Advancing Healthy Lifestyles" or "AHL") is a statewide initiative launched in January 2021 by the Delaware Department of Health and Social Services, Division of Public Health (DPH). DPH's Physical Activity, Nutrition and Obesity Prevention Program (PANO) introduced the initiative as Coronavirus 2019 (COVID-19) swept through the state, exacerbating health burdens already faced by many Delawareans. The PANO Program provides administrative staff support to the Delaware Cancer Consortium's Cancer Risk Reduction Committee (CRRC). In December 2019, the CRRC launched the Healthy Lifestyles Subcommittee (HLSC) in response to Governor John Carney's request to develop actionable policy recommendations to positively influence healthy lifestyles in Delaware. The HLSC efforts led to the recommendation of 14 policy recommendations for action in three population health strategic focus areas: 1) birth to age 18; 2) employee health and wellness; and 3) community wellness. The AHL initiative builds from the work of the HLSC and promotes the use of policy, systems, and environmental change (PSE) strategies to reduce obesity and other chronic conditions among Delawareans across the lifespan. Ideally, the AHL initiative is categorized into three component strategies: school, community, and workplace. This article highlights both completed and ongoing projects under the AHL Initiative that aim to address the burden of obesity in Delaware.