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Singh SK, Chauhan A, Alderman H, Avula R, Dwivedi LK, Kapoor R, Meher T, Menon P, Nguyen PH, Pedgaonker S, Puri P, Chakrabarti S. Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India. Matern Child Nutr 2024:e13644. [PMID: 38586943 DOI: 10.1111/mcn.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.
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Affiliation(s)
- Shri K Singh
- International Institute for Population Sciences, Mumbai, India
| | - Alka Chauhan
- The International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Harold Alderman
- The International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Rasmi Avula
- The International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Laxmi K Dwivedi
- International Institute for Population Sciences, Mumbai, India
| | - Rati Kapoor
- The International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Trupti Meher
- International Institute for Population Sciences, Mumbai, India
| | - Purnima Menon
- The International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Phuong H Nguyen
- The International Food Policy Research Institute, Washington, District of Columbia, USA
| | | | - Parul Puri
- International Institute for Population Sciences, Mumbai, India
| | - Suman Chakrabarti
- The International Food Policy Research Institute, Washington, District of Columbia, USA
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Martín-Rodríguez A, Belinchón-deMiguel P, Rubio-Zarapuz A, Tornero-Aguilera JF, Martínez-Guardado I, Villanueva-Tobaldo CV, Clemente-Suárez VJ. Advances in Understanding the Interplay between Dietary Practices, Body Composition, and Sports Performance in Athletes. Nutrients 2024; 16:571. [PMID: 38398895 PMCID: PMC10892519 DOI: 10.3390/nu16040571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
The dietary practices of athletes play a crucial role in shaping their body composition, influencing sports performance, training adaptations, and overall health. However, despite the widely acknowledged significance of dietary intake in athletic success, there exists a gap in our understanding of the intricate relationships between nutrition, body composition, and performance. Furthermore, emerging evidence suggests that many athletes fail to adopt optimal nutritional practices, which can impede their potential achievements. In response, this Special Issue seeks to gather research papers that delve into athletes' dietary practices and their potential impacts on body composition and sports performance. Additionally, studies focusing on interventions aimed at optimizing dietary habits are encouraged. This paper outlines the key aspects and points that will be developed in the ensuing articles of this Special Issue.
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Affiliation(s)
- Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (A.M.-R.); (A.R.-Z.); (V.J.C.-S.)
| | - Pedro Belinchón-deMiguel
- Faculty of Biomedical and Health Sciences, Department of Nursing and Nutrition, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
| | - Alejandro Rubio-Zarapuz
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (A.M.-R.); (A.R.-Z.); (V.J.C.-S.)
| | - Jose Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (A.M.-R.); (A.R.-Z.); (V.J.C.-S.)
| | - Ismael Martínez-Guardado
- Faculty of Health Sciences, Camilo José Cela University, C. Castillo de Alarcón, 49, Villafranca del Castillo, 28692 Madrid, Spain;
| | | | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (A.M.-R.); (A.R.-Z.); (V.J.C.-S.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
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Neupane S, Jangid M, Scott SP, Kim SS, Murira Z, Heidkamp R, Carducci B, Menon P. Availability of national policies, programmes, and survey-based coverage data to track nutrition interventions in South Asia. Matern Child Nutr 2024; 20:e13555. [PMID: 37592411 PMCID: PMC10750012 DOI: 10.1111/mcn.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023]
Abstract
Progress to improve nutrition among women, infants and children in South Asia has fallen behind the pace needed to meet established global targets. Renewed political commitment and monitoring of nutrition interventions are required to improve coverage and quality of care. Our study aimed to assess the availability of national nutrition policies, programmes, and coverage data of nutrition interventions for women, children, and adolescents in eight countries in South Asia. We reviewed relevant policy and programme documents, examined questionnaires used in the most recent rounds of 20 nationally representative surveys, and generated an evidence gap map on the availability of policies, programmes, and survey data to track progress on coverage of globally recommended nutrition interventions. Current policies and programmes in South Asian countries addressed almost all the recommended nutrition interventions targeted at women, children, and adolescents. There was a strong policy focus in all countries, except Maldives, on health system platforms such as antenatal and postnatal care and child growth and development. Survey data on nutrition intervention coverage was most available in India and Nepal, while Bangladesh and Bhutan had the least. Though countries in South Asia have committed to national nutrition policies and strategies, national surveys had substantial data gaps, precluding progress tracking of nutrition intervention coverage. Greater attention and effort are needed for multisectoral collaboration to promote and strengthen nutrition data systems.
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Affiliation(s)
- Sumanta Neupane
- Poverty, Health, and Nutrition DivisionInternational Food Policy Research InstituteNew DelhiDelhiIndia
| | | | - Samuel P. Scott
- Poverty, Health, and Nutrition DivisionInternational Food Policy Research InstituteNew DelhiDelhiIndia
| | - Sunny S. Kim
- International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Zivai Murira
- UNICEFRegional Office for South AsiaKathmanduNepal
| | - Rebecca Heidkamp
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMaylandUSA
| | - Bianca Carducci
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMaylandUSA
| | - Purnima Menon
- Poverty, Health, and Nutrition DivisionInternational Food Policy Research InstituteNew DelhiDelhiIndia
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Livingstone KM, Love P, Mathers JC, Kirkpatrick SI, Olstad DL. Cultural adaptations and tailoring of public health nutrition interventions in Indigenous peoples and ethnic minority groups: opportunities for personalised and precision nutrition. Proc Nutr Soc 2023; 82:478-486. [PMID: 37334485 DOI: 10.1017/s002966512300304x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Indigenous peoples and ethnic minority groups often experience poor diet quality and poor health outcomes. Such inequities may be partially due to nutrition interventions not meeting the unique cultural and linguistic needs of these population groups, which could be achieved using co-creation and/or personalised approaches. Cultural adaptation or tailoring of nutrition interventions has shown promise in improving some aspects of dietary intake, but this requires careful consideration to ensure it does not inadvertently exacerbate dietary inequities. The aim of this narrative review was to examine examples of cultural adaptations and/or tailoring of public health nutrition interventions that improved the dietary intake and to consider implications for the optimal design and implementation of personalised and precision nutrition interventions. This review identified six examples of cultural adaptation and/or tailoring of public health nutrition intervention in Indigenous peoples and ethnic minority groups across Australia, Canada and the US. All studies used deep socio-cultural adaptations, such as the use of Indigenous storytelling, and many included surface-level adaptations, such as the use of culturally appropriate imagery in intervention materials. However, it was not possible to attribute any improvements in dietary intake to cultural adaptation and/or tailoring per se, and the minimal reporting on the nature of adaptations limited our ability to determine whether the interventions used true co-creation to design content or were adapted from existing interventions. Findings from this review outline opportunities for personalised nutrition interventions to use co-creation practices to design, deliver and implement interventions in collaboration with Indigenous and ethnic minority groups.
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Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Vic 3220, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Vic 3220, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | | | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Nguyen PH, Sununtnasuk C, Christopher A, Ash D, Ireen S, Kabir R, Mahmud Z, Ali M, Forissier T, Escobar-DeMarco J, Frongillo EA, Menon P. Strengthening Nutrition Interventions during Antenatal Care Improved Maternal Dietary Diversity and Child Feeding Practices in Urban Bangladesh: Results of a Quasi-Experimental Evaluation Study. J Nutr 2023; 153:3068-3082. [PMID: 37354978 DOI: 10.1016/j.tjnut.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/03/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Bangladesh is urbanizing rapidly, facing challenges of malnutrition, low coverage and poor quality of urban nutrition services. OBJECTIVES We assessed the effect of integrating maternal, infant, and young child nutrition interventions, delivered at urban Maternal Neonatal and Child Health facilities, on maternal dietary diversity, iron and folic acid (IFA) and calcium consumption, and child feeding practices. METHODS We used a quasi-experimental design with a nonrandom assignment of 20 health care facilities in Dhaka to intensive and standard service arms. We conducted facility-based observations and community-based surveys at baseline (2020) and endline (2022) (n = 2455 observations and surveys with 1678 pregnant women [PW] or recently delivered women [RDW] at endline). We derived difference-in-difference (DID) estimates, adjusted for characteristics that differed at baseline or endline, and accounted for clustering. RESULTS Exposure to antenatal care (ANC) was similar in both arms: two-thirds of RDW received ANC during the first trimester and three-fourths received ≥4 ANC checkups. Compared to the standard arm, a higher proportion of PW in the intensive arm received counseling on dietary diversity (DID: 45 percentage points [pp]), and a higher proportion of RDW received IFA (25 pp) and calcium supplementation (19 pp), showed adequate weight gain (44 pp), and recorded appropriate child feeding (27 pp). Improvements were greater in the intensive than the standard arm for the number of food groups consumed (DID: 1.1 food groups) and minimum dietary diversity (23 pp); no effect was observed for IFA and calcium consumption during pregnancy. However, effects were observed for early initiation of (20 pp) and exclusive breastfeeding (45 pp), introduction of solid or semisolid foods (28 pp), and egg and/or flesh food consumption (33 pp) among children. Minimum dietary diversity and acceptable diet remained low in both arms. CONCLUSIONS Intensifying nutrition in government-aligned health care services delivered by experienced nongovernmental organization-run facilities is a feasible model to address the urban health gap, nutrition services coverage, and improve practices. The trial was registered at clinicaltrials.gov as NCT03882268.
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Affiliation(s)
- Phuong H Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States.
| | - Celeste Sununtnasuk
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | | | - Deborah Ash
- FHI Solutions, Washington, DC, United States
| | | | | | | | | | | | - Jessica Escobar-DeMarco
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, North Carolina, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
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White K, Wu B, Pilla SJ, Charleston J, Maw MTT, Appel LJ, Clark JM, Maruthur NM. Design and Implementation of a Time-Restricted Eating Intervention in a Randomized, Controlled Eating Study. Nutrients 2023; 15:nu15081978. [PMID: 37111198 PMCID: PMC10144293 DOI: 10.3390/nu15081978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
The efficacy of time-restricted eating for weight loss has not been established, as prior studies were limited by a lack of controlled isocaloric designs. This study describes the design and implementation of interventions in a controlled eating study evaluating time-restricted eating. We designed a randomized, controlled, parallel-arm eating study comparing time-restricted eating (TRE) to a usual eating pattern (UEP) for the primary outcome of weight change. Participants were aged 21-69 years with prediabetes and obesity. TRE consumed 80% of calories by 1300 h (military time), and UEP consumed ≥ 50% of calories after 1700 h (military time). Both arms consumed identical macro- and micro-nutrients based on a healthy, palatable diet. We calculated individual calorie requirements, which were maintained throughout the intervention. The desired distribution of calories across eating windows in both arms was achieved, as were the weekly averages for macronutrients and micronutrients. We actively monitored participants and adapted diets to facilitate adherence. We provide the first report, to our knowledge, on the design and implementation of eating study interventions that isolated the effect of meal timing on weight while maintaining constant caloric intake and identical diets during the study period.
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Affiliation(s)
- Karen White
- ProHealth Clinical Research Unit, School of Medicine, Johns Hopkins University, Baltimore, MD 21207, USA
| | - Beiwen Wu
- ProHealth Clinical Research Unit, School of Medicine, Johns Hopkins University, Baltimore, MD 21207, USA
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3L9, Canada
| | - Scott J Pilla
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jeanne Charleston
- ProHealth Clinical Research Unit, School of Medicine, Johns Hopkins University, Baltimore, MD 21207, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - May Thu Thu Maw
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Lawrence J Appel
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jeanne M Clark
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Nisa M Maruthur
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Comino I, Soares P, Martínez-Milán MA, Caballero P, Davó-Blanes MC. School Fruit and Vegetables Scheme: Characteristics of Its Implementation in the European Union from 2009/10 to 2016/17. Nutrients 2022; 14:nu14153069. [PMID: 35893920 PMCID: PMC9370373 DOI: 10.3390/nu14153069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
The “School Fruit and Vegetables Scheme” (SFVS) was proposed in 2009/10 as a strategy to support the consumption of Fruit and Vegetables (FV), decrease rates of obesity, improve agricultural income, stabilize markets, and ensure the current and future supply of these foods. However, there is little information about how it was carried out in the EU. Given the potential of the SFVS to support healthier, more sustainable food systems, the objective of this study was to identify the characteristics of SFVS implementation from 2009/10 to 2016/17 in the EU. A longitudinal, observational, and retrospective study was carried out based on secondary data. A total of 186 annual reports of the Member States (MS) participating in the SFVS from 2009/10 to 2016/17 were consulted: European and national budget, funds used from the EU, participating schools and students, duration of the SFVS, FV offered, and application of sustainability criteria, expenditure per student, days of the week, the quantity of FV offered per student and other indicators were calculated. The majority of MS participated in the SFVS during the study period with a heterogeneous implementation pattern in terms of funds used, coverage, duration, quantity (totals and by portion), and cost of FV distributed per student. The sustainability criteria for the FV distribution were also not applied uniformly in all the MS. Establishing minimum recommendations for SFVS implementation are recommended to maximize the benefits of the SFVS. The results may be useful for planning new strategies to help address and improve current health and environmental problems.
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Affiliation(s)
- Iris Comino
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - Panmela Soares
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - María Asunción Martínez-Milán
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
| | - Pablo Caballero
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Correspondence:
| | - María Carmen Davó-Blanes
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
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Strazza K, Jordan J, Ferriola-Bruckenstein K, Kane H, Whitehill J, Teachout E, Yarnoff B. Approaches for Implementing Healthy Food Interventions in Settings With Limited Resources: A Case Study of Sodium Reduction Interventions in Emergency Food Programs Addressing Food Insecurity. Am J Health Promot 2022; 36:487-496. [PMID: 34860600 PMCID: PMC9297099 DOI: 10.1177/08901171211056121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study describes how recipients of the Centers for Disease Control and Prevention funded Sodium Reduction in Communities Program (SRCP) worked with emergency food programs to improve access to healthy food to address chronic conditions. DESIGN SRCP recipients partnered with emergency food programs to implement sodium reduction strategies including nutrition standards, procurement practices, environmental strategies, and behavioral economics approaches. SETTING SRCP recipients and emergency food programs in Washington County and Benton County, Arkansas and King County, Washington. SUBJECTS SRCP recipient staff, emergency food program staff, and key stakeholders. MEASURES We conducted semi-structured interviews with key stakeholders and systematic review of program documents. ANALYSIS Data were analyzed using effects matrices for each recipient. Matrices were organized using select implementation science constructs and compared in a cross-case analysis. RESULTS Despite limited resources, emergency food programs can implement sodium reduction interventions which may provide greater access to healthy foods and lead to reductions in health disparities. Emergency food programs successfully implemented sodium reduction interventions by building on the external and internal settings; selecting strategies that align with existing processes; implementing change incrementally and engaging staff, volunteers, and clients; and sustaining changes. CONCLUSION Findings contribute to understanding the ways in which emergency food programs and other organizations with limited resources have implemented public health nutrition interventions addressing food insecurity and improving access to healthy foods. These strategies may be transferable to other settings with limited resources.
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Affiliation(s)
- Karen Strazza
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - Julia Jordan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather Kane
- Community Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - John Whitehill
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Teachout
- Applied Research and Evaluation Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ben Yarnoff
- Community Health Research Dvision, RTI International, Research Triangle Park, NC, USA
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Prowse R, Carsley S. Digital Interventions to Promote Healthy Eating in Children: Umbrella Review. JMIR Pediatr Parent 2021; 4:e30160. [PMID: 34842561 PMCID: PMC8663671 DOI: 10.2196/30160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND eHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. OBJECTIVE The aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). METHODS We conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. RESULTS In total, 11 systematic reviews published since 2015 were included (7/11, 64%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. CONCLUSIONS Owing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children.
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Affiliation(s)
- Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - Sarah Carsley
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
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10
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Winkler MR, Mui Y, Hunt SL, Laska MN, Gittelsohn J, Tracy M. Applications of Complex Systems Models to Improve Retail Food Environments for Population Health: A Scoping Review. Adv Nutr 2021; 13:1028-1043. [PMID: 34999752 PMCID: PMC9340968 DOI: 10.1093/advances/nmab138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/10/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022] Open
Abstract
Retail food environments (RFEs) are complex systems with important implications for population health. Studying the complexity within RFEs comes with challenges. Complex systems models are computational tools that can help. We performed a systematic scoping review of studies that used complex systems models to study RFEs for population health. We examined the purpose for using the model, RFE features represented, extent to which the complex systems approach was maximized, and quality and transparency of methods employed. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Studies using agent-based modeling, system dynamics, discrete event simulations, networks, hybrid, or microsimulation models were identified from 7 multidisciplinary databases. Fifty-six studies met the inclusion criteria, including 23 microsimulation, 13 agent-based, 10 hybrid, 4 system dynamics, 4 network, and 2 discrete event simulation models. Most studies (n = 45) used models for experimental purposes and evaluated effects of simulated RFE policies and interventions. RFE characteristics simulated in models were diverse, and included the features (e.g., prices) customers encounter when shopping (n = 55), the settings (e.g., restaurants, supermarkets) where customers purchase food and beverages (n = 30), and the actors (e.g., store managers, suppliers) who make decisions that influence RFEs (n = 25). All models incorporated characteristics of complexity (e.g., feedbacks, conceptual representation of multiple levels), but these were captured to varying degrees across model types. The quality of methods was adequate overall; however, few studies engaged stakeholders (n = 10) or provided sufficient transparency to verify the model (n = 12). Complex systems models are increasingly utilized to study RFEs and their contributions to public health. Opportunities to advance the use of these approaches remain, and areas to improve future research are discussed. This comprehensive review provides the first marker of the utility of leveraging these approaches to address RFEs for population health.
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Affiliation(s)
| | - Yeeli Mui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shanda L Hunt
- Health Sciences Library, University of Minnesota, Minneapolis, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Joel Gittelsohn
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY, USA
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11
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Eicher-Miller HA, Prapkree L, Palacios C. Expanding the Capabilities of Nutrition Research and Health Promotion Through Mobile-Based Applications. Adv Nutr 2021; 12:1032-1041. [PMID: 33734305 PMCID: PMC8166539 DOI: 10.1093/advances/nmab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/30/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Mobile-based applications are popular and prevalently used in the US population. Applications focusing on nutrition offer platforms for quantifying and changing behaviors to improve dietary intake. Such behavior changes can intervene in the relation of diet to promote health and prevent disease. Mobile applications offer a safe and convenient way to collect user data and share it back to users, researchers, and to health care providers. Other lifestyle factors like activity, sleep, and sedentary behavior, can also be quantified and included in investigations of how lifestyle is related to health. Yet, challenges in the assessment offered through mobile applications and effectiveness to change behavior still remain, including rigorous evaluation, demonstration of successful health improvement, and participant engagement. The data mobile applications generate, however, expands opportunities for discovery of the integrated and time-based nature of various daily activities in relation to health. This article is a summary of a symposium at Nutrition 2020 Live Online on the role of mobile applications as a tool for nutrition research and health promotion. The types and capabilities of mobile applications, challenges in their evaluation and use in research, and opportunities for the data they generate along with a specific example, are reviewed.
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Affiliation(s)
| | - Lukkamol Prapkree
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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12
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Chandran S, Anand AJ, Rajadurai VS, Seyed ES, Khoo PC, Chua MC. Evidence-Based Practices Reduce Necrotizing Enterocolitis and Improve Nutrition Outcomes in Very Low-Birth-Weight Infants. JPEN J Parenter Enteral Nutr 2020; 45:1408-1416. [PMID: 33296087 DOI: 10.1002/jpen.2058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants. Survivors may suffer both short- and long-term morbidities. Current evidence suggests that the incidence of NEC can be reduced by standardizing the care delivery in addressing key risk factors including an altered gut microbiome, use of formula milk, hyperosmolar feeds, and unrestricted use of high-risk medications METHODS: Since 2014, the department has a workgroup who analyzed all cases of NEC within a month of diagnosis to identify preventable risk factors. Existing evidence-based quality improvement strategies were revised and new ones were implemented sequentially over the next 4 years. These strategies include (1) a standardized feeding protocol, (2) early initiation of enteral feeding using human milk, (3) optimization of the osmolality of preterm milk feeds using standardized dilution guidelines for additives, and (4) promotion of healthy microbiome by use of probiotics, early oral care with colostrum and by restricting high-risk medications and prolonged use of empirical antibiotics RESULTS: Baseline characteristics of the patients including sex, gestational age, and birth weight were similar during the study period. After implementing the evidence-based practices successively over 4 years, the incidence of NEC in very- low birth-weight (VLBW) infants dropped from 7% in 2014 to 0% (P < .001) in 2018. The duration of parenteral nutrition, use of central line, and days to full feeds were also reduced significantly (P < .05) CONCLUSION: Adopting evidence-based best practices resulted in a significant decrease in the incidence of NEC and improved the nutrition outcomes in VLBW infants.
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Affiliation(s)
- Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore
| | - Amudha Jayanthi Anand
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore
| | - Ehsan Saffari Seyed
- Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore.,Center for Quantitative Medicine, Office of Clinical Science, Duke University-National University of Singapore Medical School, Singapore
| | - Poh Choo Khoo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore
| | - Mei Chien Chua
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore
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13
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Richards J, Arensberg MB, Thomas S, Kerr KW, Hegazi R, Bastasch M. Impact of Early Incorporation of Nutrition Interventions as a Component of Cancer Therapy in Adults: A Review. Nutrients 2020; 12:nu12113403. [PMID: 33167544 PMCID: PMC7694504 DOI: 10.3390/nu12113403] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022] Open
Abstract
Malnutrition is prevalent among oncology patients and can adversely affect clinical outcomes, prognosis, quality of life, and survival. This review evaluates current trends in the literature and reported evidence around the timing and impact of specific nutrition interventions in oncology patients undergoing active cancer treatment. Previous research studies (published 1 January 2010–1 April 2020) were identified and selected using predefined search strategy and selection criteria. In total, 15 articles met inclusion criteria and 12/15 articles provided an early nutrition intervention. Identified studies examined the impacts of nutrition interventions (nutrition counseling, oral nutrition supplements, or combination of both) on a variety of cancer diagnoses. Nutrition interventions were found to improve body weight and body mass index, nutrition status, protein and energy intake, quality of life, and response to cancer treatments. However, the impacts of nutrition interventions on body composition, functional status, complications, unplanned hospital readmissions, and mortality and survival were inconclusive, mainly due to the limited number of studies evaluating these outcomes. Early nutrition interventions were found to improve health and nutrition outcomes in oncology patients. Future research is needed to further evaluate the impacts of early nutrition interventions on patients’ outcomes and explore the optimal duration and timing of nutrition interventions.
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Affiliation(s)
- Julie Richards
- Abbott Nutrition, Bob Evans Farms, Columbus, OH 43212, USA
- Correspondence: ; Tel.: +1-740-497-7708
| | - Mary Beth Arensberg
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Sara Thomas
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Kirk W. Kerr
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Refaat Hegazi
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Michael Bastasch
- Department of Medicine and Division of Radiation Oncology, University of Texas East Health, Athens, TX 75751, USA;
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14
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Moorthy D, Merrill R, Namaste S, Iannotti L. The Impact of Nutrition-Specific and Nutrition-Sensitive Interventions on Hemoglobin Concentrations and Anemia: A Meta-review of Systematic Reviews. Adv Nutr 2020; 11:1631-1645. [PMID: 32845972 PMCID: PMC7666908 DOI: 10.1093/advances/nmaa070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/12/2020] [Accepted: 05/21/2020] [Indexed: 11/14/2022] Open
Abstract
Anemia is a multifactorial condition arising from inadequate nutrition, infection, chronic disease, and genetic-related etiologies. Our aim was to assess the impact of nutrition-sensitive and nutrition-specific interventions on hemoglobin (Hb) concentrations and anemia to inform the prioritization and scale-up of interventions to address the multiple causes of anemia. We performed a meta-review synthesis of information by searching multiple databases for reviews published between 1990 and 2017 and used standard methods for conducting a meta-review of reviews, including double independent screening, extraction, and quality assessment. Quantitative pooling and narrative syntheses were used to summarize information. Hb concentration and anemia outcomes were pooled in specific population groups (children aged <5 y, school-age children, and pregnant women). Methodological quality of the systematic reviews was assessed using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. Of the 15,444 records screened, we identified 118 systematic reviews that met inclusion criteria. Reviews focused on nutrition-specific interventions (96%). Daily and intermittent iron supplementation, micronutrient powders, malaria treatment, use of insecticide-treated nets (ITNs), and delayed cord clamping were associated with increased Hb concentration in children aged <5 y. Among children older than 5 y, daily and intermittent iron supplementation and deworming, and in pregnant women, daily iron-folic acid supplementation, use of ITNs, and delayed cord clamping, were associated with increased Hb concentration. Similar results were obtained for the reduced risk of anemia outcome. This meta-review suggests the importance of nutrition-specific interventions for anemia and highlights the lack of evidence to understand the influence of nutrition-sensitive and multifaceted interventions on the condition.
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Affiliation(s)
| | - Rebecca Merrill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sorrel Namaste
- The Demographic and Health Survey Program, ICF, Rockville, MD, USA
| | - Lora Iannotti
- Brown School, Institute for Public Health, Washington University in St Louis, MO, USA
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15
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Arensberg MB, Richards J, Benjamin J, Kerr K, Hegazi R. Opportunities for Quality Improvement Programs (QIPs) in the Nutrition Support of Patients with Cancer. Healthcare (Basel) 2020; 8:E227. [PMID: 32722026 DOI: 10.3390/healthcare8030227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
Malnutrition in patients with cancer is a ubiquitous but neglected problem that can reduce patient survival/quality of life and increase treatment interruptions, readmission rates, and healthcare costs. Malnutrition interventions, including nutrition support through dietary counseling, diet fortification, oral nutrition supplements (ONS), and enteral and parenteral nutrition can help improve health outcomes. However, nutritional care standards and interventions for cancer are ambiguous and inconsistently applied. The lack of systematic malnutrition screening and intervention in ambulatory cancer care has especially significant consequences and thus the nutrition support of patients with cancer represents an area for quality improvement. United States healthcare payment models such as the Oncology Care Model are linked to quality of care and health outcomes. Quality improvement programs (QIPs) can advance patient-centered care, perfect care processes, and help healthcare professionals meet their quality measure performance goals. Malnutrition QIPs like the Malnutrition Quality Improvement Initiative (MQii) have been shown to be effective in identifying and treating malnutrition. However, little is known about or has been reported on nutrition or malnutrition-focused QIPs in cancer care. This paper provides information to support translational research on quality improvement and outlines the gaps and potential opportunities for QIPs in the nutrition support of patients with cancer.
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16
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Rajpal S, Kim R, Joe W, Subramanian S. Stunting among Preschool Children in India: Temporal Analysis of Age-Specific Wealth Inequalities. Int J Environ Res Public Health 2020; 17:E4702. [PMID: 32629904 PMCID: PMC7370207 DOI: 10.3390/ijerph17134702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 12/05/2022]
Abstract
Adequate nutritional intake for mothers during pregnancy and for children in the first two years of life is known to be crucial for a child's lifelong physical and neurodevelopment. In this regard, the global nutrition community has focused on strategies for improving nutritional intake during the first 1,000 day period. This is largely justified by the observed steep decline in children's height-for-age z scores from birth to 23 months and presumed growth faltering at later ages as a reflection of earlier deprivation that is accumulated and irreversible. Empirical evidence on the age-stratified burden of child undernutrition is needed to re-evaluate the appropriate age for nutrition interventions to target among children. Using data from two successive rounds of National Family Health Surveys conducted in 2006 and 2016, the objective of this paper was to analyze intertemporal changes in the age-stratified burden of child stunting across socioeconomic groups in India. We found that child stunting in India was significantly concentrated among children entering preschool age (24 or above months). Further, the temporal reduction in stunting was relatively higher among children aged 36-47 months compared to younger groups (below 12 and 12-23 months). Greater socioeconomic inequalities persisted in stunting among children from 24 months or above age-groups, and these inequalities have increased over time. Children of preschool age (24 or above months) from economically vulnerable households experienced larger reductions in the prevalence of stunting between 2006 and 2016, suggesting that policy research and strategies beyond the first 1000 days could be critical for accelerating the pace of improvement of child nutrition in India.
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Affiliation(s)
- Sunil Rajpal
- Institute of Health Management Research, IIHMR University, Jaipur 302029, India;
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul 02841, Korea
- Department of Public Health Sciences, Graduate School, Korea University, Seoul 02841, Korea
- Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA
| | - William Joe
- Population Research Centre, Institute of Economic Growth, Delhi 110007, India;
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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17
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Dong KR, Flavin L, Hawkins K, Altman W. Applying a Medical Wellness Group Visit Model to a Community Setting Yielding Weight Loss and Improved Laboratory Results. Am J Health Promot 2020; 34:659-663. [PMID: 32048857 DOI: 10.1177/0890117120905241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the feasibility of applying a medical wellness group (WG) model to a community setting to improve cardiometabolic health. DESIGN This quasi-experiment was designed to compare individuals participating in the WG to participants in the control group who received general lectures on nutrition, physical activity, and sleep. SETTING A suburb north of Boston, Massachusetts. PARTICIPANTS Forty-five adults were in the WG and 10 in the control group. INTERVENTION Fourteen weekly 90-minute sessions, led by a physician and dietitian, focusing on nutrition, physical activity, and sleep, compared to controls receiving two 30-minute general wellness lectures provided within 3 months. MEASURES Pre- and postweight, waist circumference, hemoglobin A1C (HbA1c), and serum lipids; a survey measuring beliefs, attitudes, and intentions related to behavioral change. ANALYSIS T tests examined the mean change in biometric measurements. The Wilcoxon test was used to compare the ordinal questions in baseline and final survey results. The Mann-Whitney test was used to compare final survey results between groups. RESULTS The WG demonstrated desirable difference-in-difference between groups in weight (P < .001), waist circumference (P < .001), and total cholesterol (P = .03) compared to the control group. Mean change of HbA1c and triglycerides was not different between groups. Survey results showed that attitudes, perceived behavioral control, and feeling supported about wellness behaviors significantly improved from baseline to final visit in the WG (P = .002; P = .019, P = .006, respectively), but not among controls. CONCLUSION Wellness groups are feasible and provide high levels of support and accountability that empower people to make behavioral changes to improve health.
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Affiliation(s)
- Kimberly R Dong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Lila Flavin
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Wayne Altman
- Department of Family Medicine, Tufts University School of Medicine, Boston, MA, USA
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18
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Parkinson MD, Hammonds T, Keyser DJ, Wheeler JR, Peele PB. Impact of Physician Referral to Health Coaching on Patient Engagement and Health Risks: An Observational Study of UPMC's Prescription for Wellness. Am J Health Promot 2020; 34:366-375. [PMID: 32048859 DOI: 10.1177/0890117119900588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Evaluate impact of physician referral to health coaching on patient engagement and health risk reduction. DESIGN Four-year retrospective, observational cohort study with propensity-matched pair comparisons. SETTING Integrated delivery and finance system in Pittsburgh, Pennsylvania. SAMPLE 10 457 adult insured members referred to health coaching by their physician; 37 864 other members identified for health coaching through insurer-initiated outreach. INTERVENTION Practice-based, technology-supported workflow and process for physician prescribing of health coaching during regular office visit, with follow-up on patient's progress and implementation supports. MEASURES Patient engagement based on completion of pre-enrollment assessment, formal enrollment in health coaching, completion of required sessions, health risk levels, and number of health risks pre- and post-health coaching referral. ANALYSIS Difference-in-difference analysis to assess change in health risk levels and number of health risks pre- and post-health coaching and probability weighting to control for potential confounding between groups. RESULTS Members referred by a physician were significantly more likely to enroll in a health coaching program (21.0% vs 6.0%, P < .001) and complete the program requirements (8.5% vs 2.7%, P < .001) than when referred by insurer-initiated outreach; significant within group improvement in health risk levels from baseline (P < .001) was observed for both the groups. CONCLUSIONS Patients are significantly more likely to engage in health coaching when a referral is made by a physician; engagement in health coaching significantly improves health risk levels.
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Affiliation(s)
- Michael D Parkinson
- Health and Productivity, UPMC Health Plan and WorkPartners, Pittsburgh, PA, USA
| | - Tracy Hammonds
- Health Economics, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - Donna J Keyser
- UPMC Center for High-Value Health Care, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - Jennie R Wheeler
- Health and Productivity, UPMC Health Plan and WorkPartners, Pittsburgh, PA, USA
| | - Pamela B Peele
- Health Economics, UPMC Insurance Services Division, Pittsburgh, PA, USA
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19
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Salam RA, Das JK, Ahmed W, Irfan O, Sheikh SS, Bhutta ZA. Effects of Preventive Nutrition Interventions among Adolescents on Health and Nutritional Status in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Nutrients 2019; 12:E49. [PMID: 31878019 DOI: 10.3390/nu12010049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022] Open
Abstract
The objective of this review was to assess the impact of preventive nutrition interventions on health and nutritional status of adolescents aged 10–19 years in low- and middle-income countries (LMICs). We searched the databases until 5 February 2019 without any restrictions on publication, date, language, or publication status. A total of 10 studies (15 papers) including 10,802 participants assessing the impact of micronutrient supplementation/fortification were included in this review. We did not find any study assessing the impact of nutrition education and counseling or macronutrient supplementation among adolescents. Among primary outcomes, we are uncertain of the effect of iron supplementation with or without folic acid on anemia (daily supplementation; relative risk (RR): 1.04, 95% confidence interval (CI) 0.42, 2.57; one study; 1160 participants; low-quality evidence; weekly supplementation; RR: 1.07, 95% CI: 0.46, 2.52; one study; 1247 participants; low-quality evidence). We are also uncertain of the effect of various micronutrient supplementation/fortification on body mass index (BMI) (calcium/vitamin D supplementation; (MD: −0.01 kg/m2; 95% CI: −1.20, 1.17; two studies; 730 participants; I2 94%; very-low-quality evidence, iron supplementation with or without folic acid; MD: 0.47 kg/m2; 95% CI: −0.17, 1.11; two studies; 652 participants; I2 37%; very-low-quality evidence, zinc supplementation; MD: 0.35 kg/m2; 95% CI: −0.15, 0.85; one study; 382 participants; very-low-quality evidence) and multiple micronutrient (MMN) fortification; MD: 0.23 kg/m2, 95% CI: −0.11, 0.57; two studies; 943 participants; I2 22%; very-low-quality evidence). None of the included studies reported any other primary outcomes including morbidity or adverse effects. Among secondary outcomes, iron supplementation with or without folic acid may improve hemoglobin concentrations, and calcium/vitamin D supplementation may improve serum 25(OH)D levels, while calcium only supplementation and calcium and vitamin D supplementation may marginally improve total body bone mineral density (BMD). We are uncertain of the effect of MMN fortification on hemoglobin concentrations, calcium supplementation on total body bone mineral content (BMC), calcium + vitamin D supplementation on total body BMC, and zinc supplementation on zinc levels. There is limited evidence of micronutrient supplementation/fortification among adolescents, especially adolescent boys, on health and nutritional status in LMICs. These findings should be interpreted with caution due to the low quality and limited number of studies.
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Mamba NPS, Napoles L, Mwaka NM. Nutrition knowledge, attitudes and practices of primary school children in Tshwane Metropole, South Africa. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 31038344 PMCID: PMC6556922 DOI: 10.4102/phcfm.v11i1.1846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 11/29/2022] Open
Abstract
Background The increasing prevalence of being overweight and obesity in South African school children requires interventions that are evidence based. Nutrition knowledge, attitudes and practices (KAP) studies are thus needed to provide evidence for the planning of interventions that address and prevent nutrition problems in school children. Aim The aim of the study on which this article is based was to assess nutrition knowledge, attitudes and practices of grade 4–6 learners from three primary schools in a South African township. The article seeks to highlight the key results of this quantitative study. Setting The study took place in three primary schools in Mamelodi township, Pretoria, South Africa. Methods Data were collected from grade 4–6 learners using self-administered questionnaires. After coding and collating data using Epi infoTM, STATA was then used for analysis. A description of KAP results was carried out using simple descriptive statistics, while the associations were tested using a chi-square test. Results Learners displayed inadequate knowledge of a balanced diet (23%) as well as low knowledge of food groups. With regard to attitudes, the most liked food group was the drinks and snacks (72.9%), while the least liked food group was the fruits and vegetables (8.11%). With regard to practices, the most frequently consumed food group was the drinks and snacks (72.6%), while fruits and vegetables were the least consumed. However, 78.91% of the learners displayed very good nutrition-related practices, such as making their own breakfast and eating breakfast. Conclusion The inadequate knowledge displayed by learners indicates a gap with nutrition education in the curriculum. There is a need to explore innovative and novel approaches to improve nutrition knowledge of school children. Parents also need to be targeted to ensure better outcomes.
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Affiliation(s)
- Nomsa P S Mamba
- School of Health Systems and Public Health, University of Pretoria, Gezina, Pretoria.
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21
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Otelea MR, Rascu A. Vitamin D Intake and Obesity in Occupational Asthma Patients and the Need for Supplementation. Endocr Metab Immune Disord Drug Targets 2019; 18:565-572. [PMID: 29952274 DOI: 10.2174/1871530318666180628121321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/09/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Occupational asthma occurs in a significant number of adult unset forms of asthma. Even after exposure cessation, persistent asthma is frequent. Although recognized as important, nutrition, specifically vitamin D intake, was rarely evaluated in occupational asthma. OBJECTIVE To assess the vitamin D intake in occupational asthma patients and the relation with body mass index, co-morbidities related to vitamin D deficit, lung function and quality of life. RESULTS We found a reduced vitamin D intake in both irritant and allergic asthma, in obese and nonobese patients. The average intake in non-obese patients, although higher, did not reach statistical significance. We also found lower vitamin D intake in the mild asthma group versus the severe group, marginally reaching the significance level (p=0.056) at the median test. Regression analysis in asthma subpopulations revealed a different pattern of correlation, with a stronger relationship between the BMI and the impact score in irritant asthma and a closer link between vitamin D intake and symptoms score (p= 0.027) in the allergic asthma group. CONCLUSION The relation between obesity and vitamin D on clinical scores and lung function seems to be different according to the asthma phenotype. However, our study supports the usefulness of nutritional interventions in all occupational asthma patients, targeting both the reduction of the fat mass and the achievement of the recommended daily intake of vitamin D. When analyzing the impact of the weight loss effect on asthma evolution, the vitamin D status should also be considered as an influencer.
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Affiliation(s)
| | - Agripina Rascu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Colentina Clinical Hospital, Clinic of Occupational Diseases, Bucharest, Romania
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22
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Wolf WM, Wattick RA, Murray PJ, Clemmer M, Olfert MD. Future Implications of Using Registered Dietitians in Multidisciplinary Polycystic Ovary Syndrome Treatment. Healthcare (Basel) 2018; 6:E144. [PMID: 30544817 DOI: 10.3390/healthcare6040144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 01/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder in females with insulin resistance playing a key role in pathogenesis. The objective of this study was to investigate current trends and future implications of multidisciplinary PCOS clinics with inclusion of dietitians. A two-phase, formative investigation on practitioners was conducted through an anonymous survey followed by focus groups. Survey respondents included 261 health care providers from around the world; the majority (59%) representing multidisciplinary teams. Focus group participants included four dietitians, three physicians, a health psychologist and a licensed nutritionist. Primary barriers for future multidisciplinary clinics included: money/resources, insurance reimbursement, and difference of opinions. Potential advantages included: more comprehensive and integrated care, greater convenience/efficiency, and better long-term outcomes. A majority of respondents (89%) stated that dietitians should be ‘involved’ or ‘highly involved’ in treatment. The greatest challenges for dietitians include insurance, limited disease knowledge, and lack of referrals. Most providers agreed that multidisciplinary clinics would lead to a better prognosis. A greater emphasis needs to be placed on educating professionals on the importance of nutrition counseling. Access to educated dietitians is likely the best way to ensure that PCOS patients have access to lifestyle interventions.
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Korakas E, Dimitriadis G, Raptis A, Lambadiari V. Dietary Composition and Cardiovascular Risk: A Mediator or a Bystander? Nutrients 2018; 10:E1912. [PMID: 30518065 PMCID: PMC6316552 DOI: 10.3390/nu10121912] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023] Open
Abstract
The role of nutrition in the pathogenesis of cardiovascular disease has long been debated. The established notion of the deleterious effects of fat is recently under question, with numerous studies demonstrating the benefits of low-carbohydrate, high-fat diets in terms of obesity, diabetes, dyslipidemia, and metabolic derangement. Monounsaturated and polyunsaturated fatty acids, especially n-3 PUFAs (polyunsaturated fatty acids), are the types of fat that favor metabolic markers and are key components of the Mediterranean Diet, which is considered an ideal dietary pattern with great cardioprotective effects. Except for macronutrients, however, micronutrients like polyphenols, carotenoids, and vitamins act on molecular pathways that affect oxidative stress, endothelial function, and lipid and glucose homeostasis. In relation to these metabolic markers, the human gut microbiome is constantly revealed, with its composition being altered by even small dietary changes and different microbial populations being associated with adverse cardiovascular outcomes, thus becoming the target for potential new treatment interventions. This review aims to present the most recent data concerning different dietary patterns at both the macro- and micronutrient level and their association with atherosclerosis, obesity, and other risk factors for cardiovascular disease.
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Affiliation(s)
- Emmanouil Korakas
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, 124 62 Haidari, Greece.
| | - George Dimitriadis
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, 124 62 Haidari, Greece.
| | - Athanasios Raptis
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, 124 62 Haidari, Greece.
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, University General Hospital Attikon, 124 62 Haidari, Greece.
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Nolte Fong JV, Moore LW. Nutrition Trends in Kidney Transplant Recipients: the Importance of Dietary Monitoring and Need for Evidence-Based Recommendations. Front Med (Lausanne) 2018; 5:302. [PMID: 30430111 PMCID: PMC6220714 DOI: 10.3389/fmed.2018.00302] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022] Open
Abstract
Many physiological properties of the renal system influence nutrient metabolism, elimination, and homeostasis. Kidney failure poses significant challenges to maintaining adequate nutrition, most of which transplantation ameliorates. Comprehensive recommendations for managing nutritional derangements for patients with chronic kidney disease and end stage renal disease exist; however, there are only sparse guidelines for post-transplant malnutrition and adverse outcomes. Not only are guidelines limited, but little is known about dietary trends of post-kidney transplant recipients. This review describes guidelines for prevalent metabolic and nutritional complications post-kidney transplantation and also evaluates changes in caloric intake and diet composition after transplantation. This topic is important because nutrition influences allograft function and a number of cardiovascular risk factors including blood pressure, dyslipidemia, weight, and diabetes. In addition, many dietary recommendations and modifiable lifestyle changes should be tailored for specific complications of transplant patients, namely immunosuppression side effects, dietary restrictions, and electrolyte imbalances.
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Affiliation(s)
- Joy V Nolte Fong
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
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Thuita FM, Pelto GH, Musinguzi E, Armar-Klemesu M. Is there a "complementary feeding cultural core" in rural Kenya? Results from ethnographic research in five counties. Matern Child Nutr 2018; 15:e12671. [PMID: 30216678 DOI: 10.1111/mcn.12671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/19/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022]
Abstract
This investigation used data from focused ethnographic studies in five rural counties in Kenya to determine whether the concept of "special foods for infants and young children" exists in the different ethnic groups in these areas as an identifiable component of cultural beliefs and knowledge, as well as in practice, and whether they can be characterized as a "complementary feeding cultural core." The concept of "cultural core foods" refers to the set of foods that have a central role in diets of a population and, as a consequence, also have significant social and emotional components. We used the ethnographic cognitive mapping technique of "free listing" and a qualitative 24-hr recall of infants and young children (IYC) intake, with probing, to obtain data on caregivers' beliefs and behaviours. The results show that an IYC cultural food core can be identified in all of the counties. A related finding that supports the argument for an "IYC cultural core" with respect to appropriate foods for IYC is the clear cognitive consensus within sites about its content, although in practice, food insecurity and food shortage constrain household abilities to put their beliefs into practice. We conclude that interventions to improve IYC feeding in rural Kenya that build on the concept of "IYC cultural core foods" will be congruent with basic cultural ideas about managing IYC feeding and could take advantage of this cultural feature.
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Affiliation(s)
- Faith M Thuita
- School of Public Health, University of Nairobi, Nairobi, Kenya
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Enock Musinguzi
- Global Alliance for Improved Nutrition, Dar es Salam, Tanzania
| | - Margaret Armar-Klemesu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
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Finch M, Seward K, Wedesweiler T, Stacey F, Grady A, Jones J, Wolfenden L, Yoong SL. Challenges of Increasing Childcare Center Compliance With Nutrition Guidelines: A Randomized Controlled Trial of an Intervention Providing Training, Written Menu Feedback, and Printed Resources. Am J Health Promot 2018; 33:399-411. [PMID: 30004247 DOI: 10.1177/0890117118786859] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines. DESIGN Parallel group randomized controlled trial. SETTING Hunter New England region, New South Wales, Australia. PARTICIPANTS Forty-four childcare centers that prepare and provide food on-site to children while in care. INTERVENTION The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers. MEASURES Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each individual food group assessed via menu assessments. Cook knowledge of recommendations, intervention acceptability, adverse events, and barriers were also assessed via questionnaires with cooks and managers. ANALYSIS Logistic regression models, adjusted for baseline values of the outcome. RESULTS At baseline and follow-up, zero centers in the intervention and control groups were compliant with the overall menu guidelines or for the vegetable and meat food groups. Follow-up between-group differences in compliance for discretionary (33.3 vs 5, P = .18), dairy (41.7 vs 15, P = .16), breads and cereals (8.3 vs 10 P = 1.00), and fruit (16.7 vs 10, P = .48) were all nonsignificant. Relative to the control group, intervention centers showed a significantly greater increase in percentage of cooks with correct knowledge for vegetable servings (93.3 vs 36.4, P = .008). CONCLUSION Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required.
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Affiliation(s)
- Meghan Finch
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirsty Seward
- 2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Taya Wedesweiler
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Fiona Stacey
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Alice Grady
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jannah Jones
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Luke Wolfenden
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sze Lin Yoong
- 1 Hunter New England Population Health, Wallsend, New South Wales, Australia.,2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
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Pati S, Mahapatra S, Sinha R, Pati S, Samal SN. Community Management of Acute Malnutrition (CMAM) in Odisha, India: A Multi-Stakeholder Perspective. Front Public Health 2018; 6:158. [PMID: 29971225 PMCID: PMC6018096 DOI: 10.3389/fpubh.2018.00158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/10/2018] [Indexed: 11/13/2022] Open
Abstract
India remains home to nearly one-third of the world's children with severe and acute malnutrition (SAM). The present study looks at the function and implementation of a Community Management of Severe Acute Malnutrition (CMAM) programme for treatment of children with SAM in Odisha, an Indian state. A cross-sectional study design using qualitative techniques with direct observation of process and infrastructure was adopted to explore the views of stakeholders on the programme implementation. The study focuses on Kandhamal, a district in Odisha, and was conducted during June–August, 2015. Of the district and community level stakeholders involved in CMAM programme, 49 were selected as study participants using purposive sampling. In-depth interviews were conducted to obtain relevant information. Data was analyzed using data analysis software, atlas.ti version 7. The analysis demonstrated the overall acceptability, feasibility and economic viability of the programme. Additionally, the study identified several enablers (such as good response from child, village leadership involvement, multisectoral participation etc.) and barriers (such as limited awareness, increased work load, irregular staff payment etc.) linked to programme implementation. Interactions with beneficiaries and stakeholders also provided the real picture on the ground. The study emphasizes the need for stakeholders to work responsibly and in unison, and need for beneficiaries to accept, participate and contribute to the programme. In view of maximum impact, the study recommends that CMAM programmes be implemented with existing primary healthcare facilities. The study also outlines future scope for policy-level interventions and support to ensure sustainability of this healthcare delivery model.
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Affiliation(s)
- Sanghamitra Pati
- Department of Health Research, ICMR Regional Medical Research Centre, Bhubaneswar, India
| | - Sandeep Mahapatra
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, India
| | | | - Sandipana Pati
- Department of Health and Family Welfare, Government of Odisha, Bhubaneswar, India
| | - Satya N Samal
- Department of Health and Family Welfare, Directorate of Health Services, Government of Odisha, Bhubaneswar, India
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Stewart H, McLaughlin PW, Dong D, Frazão E. WIC Households' Bread and Cold Cereal Purchases: When They Use Benefits Versus Paying Out of Pocket. Am J Health Promot 2018; 33:79-86. [PMID: 29847997 DOI: 10.1177/0890117118778243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) seeks to improve the health of participating women and children by providing nutrition education and a monthly package of supplemental foods including whole grain bread and cereal. While some studies confirm that participants consume more whole grains, others find no effect. In this study, we hypothesize that the positive association between WIC and whole grains is being reduced in size and consistency by several factors. DESIGN/SETTING/PARTICIPANTS American households were surveyed about their food purchases. Overall response rate was 45.6%. A total of 4826 households completed the survey including 471 WIC households. MEASURES The survey recorded households' purchases of refined and whole grains in bread and cereal over 1 week. ANALYSIS T tests were used to compare the bread and cereal purchases of WIC and eligible, non-WIC households. Probit models were also estimated to assess a WIC household's likelihood to choose whole grain foods when using benefits versus other payment methods. RESULTS On average, WIC households acquired more whole grains in bread than eligible, non-WIC households (1.33 vs 0.72 ounce equivalents per household member aged 1 year or older; P < .05). No difference is found for cereal ( P > .10). Moreover, when using payment methods other than WIC benefits, WIC participants are 19% less likely than other households to choose whole grain bread ( P < .05) and 20% less likely to choose a whole grain cold cereal ( P < .05), which suggests that WIC-provided foods may replace some whole grains participants would otherwise buy for themselves. CONCLUSION WIC is positively associated with whole grains. However, the association is stronger for bread than cereal. Moreover, foods provided through the program may partially replace whole grains that WIC households would otherwise buy for themselves.
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Affiliation(s)
- Hayden Stewart
- 1 US Department of Agriculture, Economic Research Service (USDA-ERS), Washington, DC, USA
| | - Patrick W McLaughlin
- 1 US Department of Agriculture, Economic Research Service (USDA-ERS), Washington, DC, USA
| | - Diansheng Dong
- 1 US Department of Agriculture, Economic Research Service (USDA-ERS), Washington, DC, USA
| | - Elizabeth Frazão
- 1 US Department of Agriculture, Economic Research Service (USDA-ERS), Washington, DC, USA
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Armar-Klemesu M, Osei-Menya S, Zakariah-Akoto S, Tumilowicz A, Lee J, Hotz C. Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs. Food Nutr Bull 2018; 39:231-245. [PMID: 29486585 DOI: 10.1177/0379572117742298] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions. OBJECTIVE Our objective was to study household IYCF behaviors in 2 districts in southern and northern Ghana to identify opportunities to improve existing nutrition programs. METHODS We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall. Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data. RESULTS In both settings, children's diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few children, in tea and porridge. Fruits were seldom consumed. Household food production did not meet requirements, and the markets were heavily relied on for staples and other key ingredients. Most caregivers demonstrated basic knowledge and understanding of key health and nutrition concepts. Barriers to optimal child feeding identified were lack of money to purchase the nutritious foods recommended for children, seasonal food insecurity, and some caregiver beliefs, practices, and nutrition knowledge gaps. Positive contextual features include caregiver recognition of the dietary needs of young children and commitment to provide foods to meet these needs. CONCLUSION Our findings suggest that complementary feeding in these rural settings can be improved through reinforcement or modification of strategic components of local health and nutrition education in light of existing barriers and enablers to optimal IYCF.
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Affiliation(s)
- Margaret Armar-Klemesu
- 1 Nutrition Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Sarah Osei-Menya
- 1 Nutrition Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Sawudatu Zakariah-Akoto
- 1 Nutrition Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - James Lee
- 2 Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Christine Hotz
- 2 Global Alliance for Improved Nutrition, Geneva, Switzerland
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Shekar M, Dayton Eberwein J, Kakietek J. The costs of stunting in South Asia and the benefits of public investments in nutrition. Matern Child Nutr 2017; 12 Suppl 1:186-95. [PMID: 27187915 PMCID: PMC6680190 DOI: 10.1111/mcn.12281] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 01/22/2023]
Abstract
South Asia is home to the largest number of stunted children worldwide: 65 million or 37% of all South Asian children under 5 were stunted in 2014. The costs to society as a result of stunting during childhood are high and include increased mortality, increased morbidity (in childhood and later as adults), decreased cognitive ability, poor educational outcomes, lost earnings and losses to national economic productivity. Conversely, investing in nutrition provides many benefits for poverty reduction and economic growth. This article draws from analyses conducted in four sub‐Saharan countries to demonstrate that investments in nutrition can also be very cost‐effective in South Asian countries. Specifically, the analyses demonstrate that scaling up a set of 10 critical nutrition‐specific interventions is highly cost‐effective when considered as a package. Most of the interventions are also very cost‐effective when considered individually. By modelling cost‐effectiveness of different scale‐up scenarios, the analysis offers insights into ways in which the impact of investing in nutrition interventions can be maximized under budget constraints. Rigorous estimations of the costs and benefits of nutrition investments, similar to those reported here for sub‐Saharan countries, are an important next step for all South Asian countries in order to drive political commitment and action and to enhance allocative efficiency of nutrition resources.
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Affiliation(s)
- Meera Shekar
- Health, Nutrition and Population Global Practice, World Bank, Washington, District of Columbia, USA
| | - Julia Dayton Eberwein
- Health, Nutrition and Population Global Practice, World Bank, Washington, District of Columbia, USA
| | - Jakub Kakietek
- Health, Nutrition and Population Global Practice, World Bank, Washington, District of Columbia, USA
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Carroll GJ, Lama SD, Martinez-Brockman JL, Pérez-Escamilla R. Evaluation of Nutrition Interventions in Children in Conflict Zones: A Narrative Review. Adv Nutr 2017; 8:770-779. [PMID: 28916577 PMCID: PMC5593106 DOI: 10.3945/an.117.016121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food and nutrition insecurity becomes increasingly worse in areas affected by armed conflict. Children affected by conflict, or in war-torn settings, face a disproportionate burden of malnutrition and poor health outcomes. As noted by humanitarian response reviews, there is a need for a stronger evidence-based response to humanitarian crises. To achieve this, we systematically searched and evaluated existing nutrition interventions carried out in conflict settings that assessed their impact on children's nutrition status. To evaluate the impact of nutrition interventions on children's nutrition and growth status, we identified published literature through EMBASE, PubMed, and Global Health by using a combination of relevant text words and Medical Subject Heading terms. Studies for this review must have included children (aged ≤18 y), been conducted in conflict or postconflict settings, and assessed a nutrition intervention that measured ≥1 outcome for nutrition status (i.e., stunting, wasting, or underweight). Eleven studies met the inclusion and exclusion criteria for this review. Five different nutrition interventions were identified and showed modest results in decreasing the prevalence of stunting, wasting, underweight, reduction in severe or moderate acute malnutrition or both, mortality, anemia, and diarrhea. Overall, nutrition interventions in conflict settings were associated with improved children's nutrition or growth status. Emergency nutrition programs should continue to follow recent recommendations to expand coverage and access (beyond refugee camps to rural areas) and ensure that aid and nutrition interventions are distributed equitably in all conflict-affected populations.
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Affiliation(s)
| | - Sonam D Lama
- Chronic Disease Epidemiology, Yale University School of Public Health, and
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Moreau M, Plourde H, Hendrickson-Nelson M, Martin J. Efficacy of Nutrition Education-Based Cooking Workshops in Community-Dwelling Adults Aged 50 Years and Older. J Nutr Gerontol Geriatr 2015; 34:369-387. [PMID: 26571355 DOI: 10.1080/21551197.2015.1084257] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nutrition interventions offer an opportunity to meet the nutritional needs of community-dwelling older adults. This retrospective qualitative observational study aimed to determine if nutrition education-based cooking workshops offered in Southern Quebec helped improve dietary habits and nutrition-related knowledge, autonomy, and confidence among older adults. Participants (n = 144) in an 8-session cooking workshop program completed pre- and post-workshop session questionnaires. Baseline nutritional risk (n = 116) and body mass index (n = 112) were assessed using the Elderly Nutrition Screening Questionnaire. Paired sample t-tests and McNemar analyses were performed to determine changes over time for knowledge, autonomy, confidence and dietary habits, and specific dietary behaviors, respectively. Pearson correlation tests were performed to assess associations between variables. Significant improvements were observed over time in knowledge, confidence, and desired dietary habits but not in autonomy. At the end of the intervention a greater proportion of participants reported always consuming recommended amounts of whole grains, fruits and vegetables, water, and milk or milk alternatives. A significant association was observed between confidence and dietary habits and between knowledge and confidence. Food skills interventions that link nutrition knowledge with cooking competence offer the opportunity to improve dietary habits among community-dwelling older adults.
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Affiliation(s)
- Mireille Moreau
- a Dietetics and Human Nutrition Department , McGill University , Montreal , Québec , Canada
| | - Hugues Plourde
- a Dietetics and Human Nutrition Department , McGill University , Montreal , Québec , Canada
| | - Mary Hendrickson-Nelson
- b Dietetic Stage Clinical Coordinator (MGH), and Dietetics and Human Nutrition Department , McGill University , Montreal , Québec , Canada
| | - Joanne Martin
- c Agente de promotion des Saines Habitudes de Vie , CLSC Saint-Hubert , Saint-Hubert , Québec , Canada
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Mason JB, Shrimpton R, Saldanha LS, Ramakrishnan U, Victora CG, Girard AW, McFarland DA, Martorell R. The first 500 days of life: policies to support maternal nutrition. Glob Health Action 2014; 7:23623. [PMID: 24909407 PMCID: PMC4049132 DOI: 10.3402/gha.v7.23623] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND From conception to 6 months of age, an infant is entirely dependent for its nutrition on the mother: via the placenta and then ideally via exclusive breastfeeding. This period of 15 months--about 500 days--is the most important and vulnerable in a child's life: it must be protected through policies supporting maternal nutrition and health. Those addressing nutritional status are discussed here. OBJECTIVE AND DESIGN This paper aims to summarize research on policies and programs to protect women's nutrition in order to improve birth outcomes in low- and middle-income countries, based on studies of efficacy from the literature, and on effectiveness, globally and in selected countries involving in-depth data collection in communities in Ethiopia, India and Northern Nigeria. Results of this research have been published in the academic literature (more than 30 papers). The conclusions now need to be advocated to policy-makers. RESULTS The priority problems addressed are: intrauterine growth restriction (IUGR), women's anemia, thinness, and stunting. The priority interventions that need to be widely expanded for women before and during pregnancy, are: supplementation with iron-folic acid or multiple micronutrients; expanding coverage of iodine fortification of salt particularly to remote areas and the poorest populations; targeted provision of balanced protein energy supplements when significant resources are available; reducing teenage pregnancies; increasing interpregnancy intervals through family planning programs; and building on conditional cash transfer programs, both to provide resources and as a platform for public education. All these have known efficacy but are of inadequate coverage and resourcing. The next steps are to overcome barriers to wide implementation, without which targets for maternal and child health and nutrition (e.g. by WHO) are unlikely to be met, especially in the poorest countries. CONCLUSIONS This agenda requires policy decisions both at Ministry and donor levels, and throughout the administrative system. Evidence-based interventions are established as a basis for these decisions, there are clear advocacy messages, and there are no scientific reasons for delay.
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Affiliation(s)
- John B Mason
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA;
| | - Roger Shrimpton
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Lisa S Saldanha
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cesar G Victora
- Department of Social Medicine, Faculty of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Deborah A McFarland
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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