Nutrition Department Dissertations Collection

Dietary patterns and their relationship to sociodemographics, health behaviors, and the risk of hypertension among adults in Pakistan

Safdar, Nilofer Fatimi — Wed, 16 Jan 2013 12:25:07 PST

According to the World Health Organization (WHO), Pakistan is facing a rapid rise in non-communicable diseases associated with lifestyle changes in urban cities. Nutrition and diet are key components of lifestyle modification factors that can help prevent and reduce the disease burden in Pakistan. Recently, dietary patterns became commonly used assessment method to examine the effects of an overall diet, representing a broader picture of food and nutrient consumption on health and disease outcome. ^ The first paper of this dissertation identifies key dietary patterns using factor analysis, examining their relationship to sociodemographic, anthropometric and lifestyle factors among 5,491 adults from the Control of Blood Pressure and Risk Attenuation (COBRA) study in Pakistan. Three dietary patterns were identified using a culturally-derived food frequency questionnaire and were labeled as: the "fat and sweet"; the "fruit and vegetable"; and the "seafood and yogurt" patterns. The fat and sweet pattern was inversely associated with male gender and abdominal obesity, and was positively associated with being single, unmarried and between 15-39 years old. The fruit and vegetable and seafood and yogurt patterns were positively associated with increased educational status, physical activity and non-tobacco use. ^ The second paper further examines the association between the identified dietary patterns and hypertension. Age, education, body mass index, marital status and sprinkling salt on cooked food were independently associated with hypertension in this population. Adjusted odds ratios for hypertension in the seafood and yogurt pattern scores were most protective, some protection was observed with the fruit and vegetable pattern and no significant association was seen for the fat and sweet pattern. ^ The third paper provides an additional dimension to the relationship of dietary patterns and health outcomes by evaluating the nutritional biomarkers relevant to cardiovascular disease among the COBRA cohort who were ≥ 40 years. In men, the fat and sweet pattern across the quartiles was positively associated with total lipids, triglycerides and negatively with blood glucose when adjusted for covariates. In women association was only seen for seafood and yogurt pattern. ^ These findings may hold some relevance in study of dietary patterns and health and disease outcome among Pakistanis.^

Relationship between learning style and knowledge, attitude, and behavior change in nutrition education

Beffa-Negrini, Patricia A — Wed, 19 Jul 2006 14:28:17 PDT

We used Kolb's Model of Experiential Learning and learning style (LS) theory to design a group workshop (GW) and correspondence course (CC) to instruct adults on reducing cancer risk through diet. Kolb's model has four stages: having a concrete experience, reflecting on that experience, forming abstract concepts about the experience, and actively experimenting with what has been learned. Individuals prefer one stage of learning and are classified into four LSs: divergers, assimilators, convergers, and accommodators. The purpose of the study was to test the relationship of LS and instructional method to knowledge, attitude, and behavior change; knowledge and attitude maintenance ten weeks after instruction; and course attrition.^ Through mass media we recruited adults interested in diet and cancer prevention. Subjects completed Kolb's LS Inventory II (an instrument to determine LS), demographic questionnaire, and knowledge, attitude, and behavior pretests. Subjects were randomly assigned, by LS, to the GW, CC, or control group. Following the educational intervention, participants completed posttest measures of knowledge and attitude and delayed posttests of knowledge, attitude, and behavior.^ Both courses improved knowledge and attitude at posttest. However, knowledge gain was not maintained in either course, but attitude was maintained in the CC. Each course increased self-reported behavior scores, but only the GW values were significantly greater than controls. The CC improved "Yellow and Dark Green Vegetable" intake and lowered fat consumption in those subjects who had high fat intakes before the study began.^ No relationship was found between LS and knowledge and attitude change or maintenance, self-reported behavior, nutrient intake, nutrient density, or attrition. However, the converger LS had a significant decrease in consumption of citrus fruits at delayed posttest as compared to divergers and accommodators. In addition, convergers attending the GW had decreased fruit and vegetable consumption. The negative outcomes of convergers in the GW may be due to their preference for technical tasks rather than people.^ Thus, successful knowledge, attitude, and behavior change can result from nutrition education programs designed to reach all learning styles. Further research is needed to compare Kolb's model to other theories of behavior change and maintenance. ^

Poverty, household food availability and nutritional well-being of children in north west Syria

Ghosh, Shibani A — Wed, 19 Jul 2006 14:18:29 PDT

In Syria, 3.5 million are classified as rural poor. Rural women and children, suffer the most from poverty and its physical and social deprivations. A study compared differences in child growth and nutrition in three rural livelihood groups: a ‘barley-livestock’ group, an ‘olive/fruit tree’ group and an irrigation group of Aleppo province, Syria. Informal interviews, food card sorts exercise, key informant socio-economic evaluation, household food frequency and portion size questionnaires, health questionnaires, and anthropometry were conducted. Two hundred and four households, 541 rural and 199 urban middle-income children (2–10 years) were interviewed and measured. Independent sample t-tests, one-way analysis of variance, GLM univariate analysis of variance and linear regression analysis were used. Stunting prevalence was highest in the barley-livestock (23%) and lowest in the irrigation group (12.5%). Girls in the barley-livestock group displayed the highest rates of stunting (28.3%), followed by boys (22%) and girls (21.08%) in the olive/fruit tree group. The prevalence of underweight children was highest in the barley-livestock and olive/fruit tree groups (14.29% and 13.25% respectively). Wasting did not occur in the irrigation group, while rates were very low in both the barley-livestock (0.96%) and olive/fruit tree (2.17%) groups. Percentages of poor households were high in the barley-livestock and olive/fruit tree groups (60 and 59%). They also had lower milk product availability, a major source of protein in the diet. Total food energy was high in all groups while dietary quality was poor in the barley-livestock and the olive/fruit tree groups. The diets were high in food energy from sugar, in cereal protein and low in lysine (mg/g protein) calcium, and vitamin A and vitamin B-12 in the case of the barley-livestock group. Dietary, demographic and economic variables significantly explained some variation in the growth indices. The barley-livestock group and the olive/fruit tree group children are most vulnerable to poor nutrition. Poverty and poor nutrition existed in pockets through Aleppo province irrespective of agricultural stability zone. Nutritional status is a good indicator of agricultural livelihoods and can be used to devise effective development interventions for Aleppo province. ^

Nutritional impact of resettlement of internally displaced people in Northern Iraq

Acharya, Pushpa — Wed, 19 Jul 2006 14:07:33 PDT

A survey aimed at assessing the nutritional impact of resettlement of Internally Displaced Persons (IDPs) was conducted in Northern Iraq between July and November 2000. The sample consisted of 301 households in the collective town of Dyana, representing the IDPs, and 282 households in ten villages of Rostey Valley, representing the resettled IDPs. The methodology consisted of structured questionnaires, anthropometry, and measurement of hemoglobin levels of one child under the age five years, one adult mate, and one adult female per household. The prevalence of low height-for-age among the children from the resettled households was 30.6% and among those still in the collective town was 18.9% (p < 0.01). Incidence of diarrhea was more than three times and acute respiratory infection (ARI) was more than seven times among the children in the collective town (p < 0.01). No significant differences existed in acute malnutrition and underweight rates among the children or in adult BMIs between the two populations. Anemia was present among 56.8% of the children in the collective town and among 46.8% of the children in the resettled villages (p < 0.01). When children who had diarrhea and ARI during the two weeks prior to the survey were removed from the analysis, the difference was not statistically significant, suggesting that the higher prevalence rate of anemia in the collective town may be due to higher infection rate. The presence of anemia among both male (42.9%) and female (47.2%) adults was significantly higher among the IDPs in the collective town than among the male (22.5%) and female (28.0%) adults in the resettled villages (p < 0.01). Except for vegetables, all other types of food were available in higher quantities to the resettled households (p < 0.05). Availability of food energy, protein, iron, zinc, thiamin, and folic acid was significantly higher in the resettled villages and availability of calcium, riboflavin, and vitamins C and A was significantly higher in the collective town (p < 0.05). The IDPs in the collective town had better diet diversity (p < 0.05). These results show that the resettled IDPs did not have a superior nutritional status than those still considered IDPs. ^

The effect of rural-to-urban migration on the diet and nutritional status of a peri-urban population in Iran

Giahi, Fatemeh — Wed, 19 Jul 2006 14:03:21 PDT

In spring 1994, a survey covering a total of 300 households was carried out to study the effect of rural-to-urban migration on nutritional status of recent migrants in Islamshahr, a peri-urban area of Tehran, Iran. The sample consisted of 97 long term migrant, 96 short term migrant and 107 rural households. The study revealed that intake of food energy, protein and almost all nutrients was higher among migrants. On average, both migrant and rural population had intakes of zinc and riboflavin below the requirements. In addition, the rural population had low intakes of vitamin C due to lower consumption of vegetables and poorer food diversity. About 26% of migrant children were stunted compared to 21% rural. The peak of stunting for short term migrant children was in 3–4 years age group suggesting a pre-migration history of chronic malnutrition. The prevalence of both underweight and overweight was higher for short term migrant adults. These facts and the observed better standard of living for the migrants suggest that rural-to-urban migration was mainly the result of rural-urban socio-economic inequalities which has to be addressed in the country's development policies. ^