Nutrition Department Masters Theses Collection

The Massachusetts BMI Letter: Parents' Responses, Conceptualizations of Weight, and Health Literacy Skills

Moyer, Lindsay J. — Fri, 23 Nov 2012 07:33:14 PST

BACKGROUND: Since 2010, nurses in Massachusetts public schools have conducted state-mandated Body Mass Index (BMI) screening of first, fourth, seventh, and tenth graders and communicated results in a letter to parents/caregivers. The objective of this study was to explore parents’ responses to the BMI letter and their experiences with weight-related language used by health professionals. These two areas were examined in the context of parents’ health literacy skills and readability of the letter. METHODS: Readability of the letter was calculated using five common formulas. One-hour focus groups were conducted using a semi-structured interview guide with a convenience sample of parents/caregivers of 8- to 14-year-old obese children participating in a weight management program. Parents were asked to share reactions to 10 weight terms in random order. Parents also completed a written version of the Newest Vital Sign (NVS) health literacy assessment. Focus group data were transcribed verbatim, and content analyses conducted to identify emergent themes. Descriptive statistics were calculated for NVS scores. RESULTS: Reading-level estimates of the BMI letter ranged from fifth to seventh grade. Twenty-nine individuals participated in eight focus groups (83% female, mean age 41 yrs+9 yrs, 59% self-identified as Hispanic/Latino). NVS scores for 12 participants (41%) indicated a possibility (n=7) or high likelihood (n=5) of limited health literacy. “Emotions” emerged as a major theme. Parents expressed concern, guilt, fear, anger, rationalization, skepticism, and acceptance regarding the letter and weight-related terms. Parents had mixed reactions to the letter: finding the information helpful, voicing concern about privacy and self-esteem, and displaying confusion when interpreting the weight status. A majority (67%) of parents who expressed confusion about the letter or weight terminology received an NVS score indicating a possibility or high likelihood of limited health literacy. Among the weight terms, parents preferred weight, weight problem, and unhealthy weight more than obese or extremely obese. CONCLUSIONS: This is the first known study to evaluate how parents respond to and comprehend the Massachusetts BMI letter. Emergent themes could be used to inform quantitative assessment of communication challenges associated with the letter. This study has implications for respectfully and effectively communicating BMI results nationwide.

Western Massachusetts Head Start Preschoolers' Vegetable Consumption in Response to a Puppet-Based Nutrition Education Intervention Focusing on the Sensory Properties of Vegetables

Magro, Arielle M. — Thu, 23 Aug 2012 06:28:01 PDT

Multi-sensory nutrition education interventions aimed at promoting children’s preferences for vegetables have the potential to positively impact children’s intake of essential micronutrients and phytochemicals. We implemented our intervention in Western Massachusetts Head Start preschool classrooms, as part of Massachusetts Farm Fresh research project. Social cognitive theory, early childhood developmental milestones, and the play approach to learning provided the framework. During the 4-week intervention, eight vegetables were matched by appearance and growing process to create vegetable pairs (green bean-sugar snap pea, broccoli-cauliflower, beet-radish, and carrot-parsnip). Each week, two animal puppets introduced the children in the classroom to the vegetable pairs by highlighting the vegetable’s color, shape, texture, and growth process. Complete baseline and follow-up consumption data were available for 60 three to five year old children. Total mean consumption (g) increased pre-post intervention (pre: 14.75 + 1.38 vs. post: 17.83 + 2.05 g) (p= 0.06). Specifically, mean consumption (g) increased for peas (pre: 1.32 + 0.26 vs. post: 2.03 + 0.36 g) (p=0.04), parsnips (pre: 1.31 + 0.24 vs. post: 2.06 + 0.35 g) (p=0.04), and for the high-sugar content vegetables (pre: 7.41 + 0.82 vs. post: 9.75 +1.14 g) (p=0.02). Mean consumption of the red and white colored vegetables respectively were (pre: 2.66 + 0.41 vs. post: 3.68 + 0.54 g) (p=0.07) and (pre: 2.81 + 0.46 vs. post: 3.93 + 0.61) (p=0.08). Findings suggest that a puppet based nutrition education intervention highlighting the sensory attributes has the potential to increase young children’s consumption of vegetables.

Sensory Exploration of Seasonally and Locally Available Vegetables and its Effects on Vegetable Consumption of Western Massachusetts Head Start Children

Sojkowski, Shannon — Thu, 23 Aug 2012 06:19:41 PDT

The current exploratory study, as part of the Massachusetts Farm Fresh (MAFF) research project: 1) examined the effect sensory attributes (i.e. taste profile, color, shape, texture, growth pattern) of the target vegetables have on children’s willingness to explore and consumption and 2) compared these outcomes for: facilitator-guided (FG), vs. children’s self-guided (SG) exploration.

We conducted a 6-week multi-sensory nutrition education intervention with Western Massachusetts Head Start preschoolers (3-5 years of age; n=94 children) using eight vegetable pairs; outcome measures were recorded by observers. Data were analyzed using SPSS version 20.0. Results are reported for 50 children with complete data at both baseline and follow-up.

Willingness improved from baseline (40-50% of children = SCORE O) to follow-up (20-40% = SCORE 0) for all vegetables. Willingness scores (1) increased for “lower-sugar” vegetables (broccoli, cauliflower, green bean, radish) (p=.013) (2) were lower for white vegetables (cauliflower, parsnip) versus the other color categories (red, green, orange) and (3) were higher for both pod (sugar snap peas, green beans) and long-root (carrot, parsnip) versus root vegetables (beet, radish).

Pre-post mean (SE) consumption (g) increased for carrots (p=.013) (2.45+/-.39 vs 3.49+/-.43) and radishes (p=.023) ( .90+/-.22; vs 1.45+/-.29) ). At follow-up consumption of ”higher-sugar” vegetables was greater (p=.000) and carrot-parsnip pair was higher than broccoli-cauliflower (mean difference 1.49+/-.51) (p=.005) and beet-radish1.01+/-.55) (p=.071) pairs.

Overall, children’s willingness and consumption varied by sensory attributes of the vegetables. The multi-sensory approach successfully activated children’s senses while providing exposure to a variety of local vegetables in the Head Start setting.

The Effectiveness of Point-of-Purchase Nutrition Education on Improving Beverage Choices and Nutrition Knowledge in a College Foodservice Setting

Wemhoener, Heather A. — Thu, 23 Aug 2012 05:54:34 PDT

College students are among the highest consumers of sweetened beverages, drinking more than 25% of their daily calorie needs from sweetened drinks. They also tend to be low consumers of milk. This is important, as high consumption of sweetened drinks and low consumption of nutrient-dense drinks is associated with obesity, dental caries and bone disease. Point-of-purchase (POP) marketing and nutrition education programs are thought to be effective in changing food selection behaviors of college students. Therefore, we conducted a 2-week intervention that combined POP marketing and nutrition education aiming to 1. decrease sweetened beverage consumption 2. increase milk/milk equivalent consumption and 3. increase knowledge of beverages and health among University of Massachusetts students.

To determine effectiveness of the campaign, college students enrolled at UMass Amherst with a meal plan of > six meals/week were recruited via email for survey participation prior to (n=1547) and 14 days after (n=1387) the intervention. We compared self-reported beverage consumption and nutrition knowledge for pre- versus post-intervention and exposed versus unexposed (post-intervention) survey respondents with Chi-square tests. Using both approaches to assess campaign effectiveness, we found that exposed participants were less likely to drink regular soda at least once per week (p =0.001, p = 0.044), more likely to identify fruit juice is not a source of calcium/vitamin D (p<0.001, p = 0.011) and more likely to identify that there is a link between artificial sweeteners and hunger (p<0.001, p<0.001).

We found that POP marketing was effective in decreasing soda consumption and increasing nutrition knowledge about calcium/vitamin D and artificial sweeteners in our study. These results suggest that similar POP marketing campaigns may be useful in college settings to improve beverage choices and knowledge. Successful campaigns that impact long-term behavior may also improve long-term health outcomes for college students by decreasing sweetened beverage intake.

Association between Dietary Intake and Nutritional Status among Adolescent Girls in Kilosa District, Tanzania

Chen, Shanshan — Thu, 12 Apr 2012 01:11:25 PDT

Underweight and stunting are highly prevalent public health problems in developing countries, particularly among populations exposed to food insecurity and chronic malnutrition. Underweight results from relatively recent malnutrition whereas empirical research has shown that early childhood malnutrition is a strong predictor of stunting. Dietary diversity has been recognized as an indicator of food security, with consumption of more food groups suggesting better nourishment. Greater dietary diversity has been associated with better nutritional outcomes and improved micronutrient intake. Zinc, an essential mineral, plays a critical role in child growth and development. A deficiency in Zinc may contribute to increased risk for stunting in childhood and adolescence.

This cross-sectional study examined the independent associations between underweight, stunting, dietary diversity, and dietary intake of zinc among a sample of never-married adolescent girls (n=307) living in Kilosa District, Tanzania. Dietary, anthropometric, physical activity, morbidity and demographic data were collected. The associations between underweight (determined as weight by age less than 5^th percentile of WHO reference) and dietary diversity (defined by the number of food groups consumed by adolescent girls); as well as stunting (determined as height by age less than 3rd percentile of WHO reference) and dietary intake of zinc were tested using multivariate analyses.

We found that adolescent girls’ diets were largely deficient in macronutrients and micronutrients, with the mean intake of energy and protein being 810kcals/d and 21.9g/d, respectively. The rates of underweight and stunting were 16.2% and 62.2%, respectively. Greater dietary diversity was associated with decreased risk of underweight among adolescent girls, after adjusting for confounders including age, village location, school enrollment, pubertal status, socioeconomic status and energy intake, (OR, 0.55, 95%CI 0.39-0.98, p<0.05). Similarly, higher intake of zinc was found to be associated with lower risk of stunting, after controlling for age, physical activity, BMI, energy intake and individual’s dietary diversity (OR, 0.87; 95%CI, 0.76-0.99, p<0.05). In conclusion, these findings suggest that dietary diversity and nutrient intake, especially intake of zinc, may play an important role in the long-term nutritional health of adolescent girls. Longitudinal studies examining these associations in developing countries settings are needed.

Effect of the Flavonoid Quercetin on Adipocytes

Swick, Jennifer C. — Mon, 21 Nov 2011 09:37:55 PST

Obesity is an urgent global public health concern as prevalence rates continue to increase, especially among children. At the cellular level obesity is defined by an increase in adipocyte number (hyperplasia) and size (hypertrophy). Both lead to the dysfunction of adipose tissue, which has been identified as the link between obesity and chronic disease. Bioactive compounds, naturally occurring in fruits and vegetables, hold enormous potential in regulating adipocyte biology. Quercetin, the most commonly consumed dietary flavonoid, is a strong potential anti-obesity agent that has been implicated as an AMP-activated protein kinase (AMPK) activator and shown to ameliorate symptoms of metabolic syndrome in vivo. Here we investigated quercetin’s effect on (1) adipogenesis, the process of increasing adipocyte number, and (2) metabolism of mature adipocytes. In 3T3-L1 preadipocytes, quercetin dose-dependently inhibited adipogenesis, as evidenced by decreased lipid accumulation and expression of adipogenic markers such as peroxisome proliferator-activated receptor (PPAR) γ, CCAAT/ enhancer binding protein (C/EBP) α, adipocyte fatty acid binding protein 2 (aP2), and acetyl-CoA carboxylase (ACC) on mRNA and protein levels. This inhibitory effect was limited to the early stages of adipogenesis (0-36 hours), and quercetin treatment altered the normal expression pattern of cell cycle related genes Cyclin A and p27, indicating quercetin may inhibit adipogenesis through cell cycle events. We next investigated quercetin’s ability to activate AMPK and the metabolic pathways related to AMPK activation: lipolysis and b-oxidation. Quercetin increased phosphorylation of AMPK and its downstream target ACC. Further, quercetin treatment (100μM) increased free fatty acid content in the media through an AMPK-dependent mechanism. Quercetin up-regulated mRNA expression of uncoupling proteins 3 (UCP3) and peroxisome proliferator-activated receptor-gamma co-activator 1 alpha (PGC-1a), indicating that quercetin may induce mitochondrial oxidative pathways, also through an AMPK-dependent pathway. These findings suggest (1) quercetin inhibits adipogenesis through the regulation of early cell cycle events required for adipogenic differentiation, and (2) quercetin’s activation of AMPK induces lipolytic and oxidative pathways. Taken together, quercetin could be further developed as an anti-obesity agent because of its potential to inhibit both hyperplasia and hypertrophy in vitro.

Perceptions and Attitudes of Dietetic Program Educators Regarding Use of Distance Education and Computer-Based Simulations in Dietetics Education

Schlein, Kirsten M. Ms. — Mon, 21 Nov 2011 09:35:50 PST

Distance education (DE) can address barriers to training nutrition professionals by offering a convenient, flexible and efficient way of learning. One particularly valuable teaching tool in DE is the use of computer-based simulations (CBS). CBS stimulates confidence building, acquisition of new knowledge, exposure to new and challenging patient cases in a safe learning environment, development of communication and critical thinking skills, and the cultivation of sensitivity towards patient needs. Despite the benefits, there is a lack of research examining dietetic educator’s perceptions of and experience with CBS. Goals of this study were to determine: 1) whether dietetic program educators were open to the idea of using CBS and how these responses varied in relation to different factors, and 2) dietetic program educators’ perceptions of the benefits and barriers of using CBS. Secondary data analyses were conducted on a15-item survey developed by the American Dietetic Association (ADA). Surveys contained two qualitative questions and 13 quantitative questions related to CBS. Surveys were e-mailed via the ADA listserv to 535 program directors, including Dietetic Internship Programs (DI), Coordinated Programs in Dietetics (CP), Didactic Programs in Dietetics (DPD), and the Dietetic Technician Programs (DT). A total of 165 individuals responded to the survey. The majority of respondents were open to the use of CBS (n=117) and a small number were not open (n=24). Respondents open to CBS were more likely to 1) not prefer face-to-face communication with their students and colleagues 2) currently be using online case studies and simulations 3) be using standardized patients in supervised practice 4) believe that dietetics education needs alternatives to traditional supervised practice such as CBS 5) believe that they have IT and financial support from their administration 6) have medical simulation laboratories available for dietetics students 7) believe that they had the technological skills needed to use CBS. Educators commented on the potential for CBS to address the shortage of preceptors and facilities available for supervised practice, in addition to enhancing and expediting learning in various settings. Perceived barriers, included the idea that technology impedes learning and a concern about the resources needed to implement CBS. Understanding the perspectives and practices of education program directors is a crucial component of furthering the process of incorporating CBS into nutrition education. This is exciting new terrain for nutrition education and moving forward with research in both distance education and CBS will be beneficial to enhancing nutrition and dietetics education in DE, traditional classroom settings and in supervised practice.

Vitamin D and TNF-alpha Effects on Adipogenesis and Inflammation in Human Adipocytes

Gray, Brianna — Mon, 21 Nov 2011 09:25:52 PST

Obesity accounts for $168 billion in annual medical expenses and increases the risk of cardiovascular disease, cancer, and type-2 diabetes, three diseases responsible for over 50% of deaths in the United States. It is well established that the pattern of adiposity is an important factor in the relationship with disease risk and that visceral adiposity, which favors hypertrophy (characterized by enlarged cells) is more dangerous than subcutaneous adiposity, which tends to be hyperplastic (characterized by an increase in cell number). Hypertrophy is associated with inflammation and insulin resistance, and hyperplasia (adipogenesis, i.e., the formation of new adipocytes), is associated with improved insulin sensitivity. Tumor necrosis factor-alpha (TNF-alpha) is a potent pro-inflammatory cytokine that activates a nuclear factor-kappa B (NF_KB) intracellular pathway that is an important mediator of obesity-associated insulin resistance and increased risk of type-2 diabetes. Interestingly, obesity has been positively associated with both low vitamin D status and elevated levels of TNF-alpha. Our studies focused on examining the influence of the active vitamin D hormone, 1,25-dihydroxyvitamin D, and TNF-alpha on adipogenesis and inflammation in human primary adipocytes and determining whether the balance of these two factors influences the extent to which adipocytes accumulate lipid or express pro-inflammatory cytokines. We found no effect of 1,25-dihydroxyvitamin D on adipogenesis or pro-adipogenic gene expression despite a clear upregulation of a vitamin D responsive gene, 24-hydroxylase, in response to treatment with 1,25-dihydroxyvitamin D. TNF-alpha clearly inhibited adipogenesis and expression of PPAR-gamma and C/EBP-alpha and enhanced expression of the pro-inflammatory cytokines IL-6 and MCP-1, but not IL-8. There was a trend towards a dose-dependent downregulation of MCP-1 by 1,25-dihydroxyvitamin D in three individuals; however, this effect was not statistically significant. While we found no interaction between TNF-alpha and 1,25-dihydroxyvitamin D on adipogenesis, there is a potential anti-inflammatory action of 1,25-dihydroxyvitamin D in human primary adipocytes. Future studies into this potential are warranted in light of the growing obesity epidemic and the interest in finding nutritionally modifiable treatment or prevention strategies to mitigate the negative consequences of obesity.

the Relationship between Vitamin D Statuses and Young Adult Women Asthma

Bian, Shiying — Tue, 29 Mar 2011 19:13:45 PDT

Although maternal vitamin D status has been linked to asthma in offspring, the relationship between vitamin D status and asthma in adults still remains unclear. The current study assessed the relationship between measures of vitamin D status and self-reported asthma/wheeze in 186 healthy women aged 18-30 years. Although the risk of asthma/wheeze symptoms was three-times higher among women with low dietary vitamin D intake (<200 IU>/day) than in those with higher vitamin D intake, suboptimal serum levels of 25(OH)D ( <70 nmol>/L) were associated with a 48% lower risk of asthma/wheeze than “optimal” serum levels. These contradictory effects underscore the poor correlation between dietary vitamin D intake and serum vitamin levels and suggest that other components in vitamin D-rich foods may be protective. Alternatively, women with higher serum vitamin D levels may have spent more time outdoors, increasing their exposure to asthma triggers. This study also identified predictors of serum 25 (OH) D in this sample. In addition to total dietary vitamin D (r= 0.2; p=0.03), intake of cold cereal (p=0.02) also significantly predicted serum 25(OH)D levels. Among non-dietary factors, month of blood draw (p=0.05) and oral contraceptive use (p<0.0001) were positive predictors of serum 25(OH) D; sunscreen use (p=0.04) was a negative predictor. After adjusting for covariates, oral contraceptive use was associated with 25(OH)D levels that were on average 24 nmol/L greater than those observed in women who did not use oral contraceptives. Additional prospective studies are needed to further evaluate the relationship between vitamin D status and asthma.

Iron Status, Inflammation and Anemia in Bangladeshi Women Exposed to Arsenic

Faraj, Joycelyn M. — Tue, 29 Mar 2011 19:12:52 PDT

Iron depletion (ID) is the most common nutrient deficiency worldwide and is the leading cause of anemia. Chronic arsenic (As) exposure is a major public health problem in Bangladesh and triggers inflammatory responses that render iron status assessment challenging. We assessed the prevalence of ID and iron deficiency anemia (IDA) in 147 arsenic-exposed Bangladeshi women (75 skin lesion cases; 72 controls), ages 18-33 years, who were part of a skin lesion study. Hemoglobin (Hb) was measured in whole blood; ferritin and hs-c-reactive protein (CRP) were measured in serum. The prevalence of anemia (Hb<120g/L) was 18%. Although the prevalence of ID (ferritin≤12mcg/L) did not differ between cases and controls, anemia was more common among cases (25% vs. 10%; p=0.02). Of anemic women, 27% (N=7) also had ID (Hb<120g/L and ferritin≤12mcg/L), indicating IDA. Women with normal iron status had higher toenail arsenic compared to iron-depleted women (2.9 vs 1.4 µg As/g toenail; p=0.00), and their water arsenic concentration was higher than that of iron-depleted women (18.8 vs 6.2 µg As/L; p=0.03); every 1µg increase in toenail As was associated with a 45% lowered risk of ID (OR=0.55, 95%CI=0.33,0.94). Much of the anemia in this cohort appears unrelated to ID, but could be linked to other nutrients, such as folate and vitamin B12, which are involved in both hematopoiesis and arsenic metabolism. It is possible that arsenic exposure in this cohort compromised folate and vitamin B12 status.