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PubMed1984

Evaluating primary health care and nutrition programs in the context of national development.

This paper illustrates an evaluation model incorporating research techniques of both primary health care and social anthropology. The case in point is the Jamaican Government's Community Health Aide Programme, which employs over 1300 auxiliary health workers to serve the low-income population of the island. The study demonstrates a cardinal principle of the anthropological approach--a grounded and holistic understanding of the social and environmental context is necessary to translate data into useful information. The study demonstrates connections between the distribution of care, the power of the cosmopolitan medical profession, and the Jamaican political patronage system. Finally, the impact of the program is assessed on child growth measures against the background of the Jamaican economy as it evolved from 1970 to 1980.

Community Health Workers↗
PubMed1976

Menu planning in the Nutrition Program for the Elderly. Modified Nutrient Standard Menu method.

A nutrient standard menu (NSM) planning method was developed for use in planning menus which provided one-third the Recommended Dietary Allowances for persons sixty years of age or older for nine indicator nutrients and calories, while restricting fat to less than 40 per cent of total calories. To eliminate manual calculations and make it easy for individuals untrained in dietetics or nutrition to use NSM planning, the nutrient composition of over a thousand commonly used menu items was listed in a menu planning manual in nutrient units which were one-tenth of the nutrient standard for the meal. Menus from third-party sources were monitored by selecting similar nutritionally analyzed menu items in the manual and adjusting the nutrient composition to conform to the portions actually served. Ten site managers of the Administration on Aging (AoA) evaluated the planning/monitoring method. The members of the group, on the average, were fifty-six years of age, had 1.6 years of education beyond high school, and had 4.6 years of foodservice experience. Approximately 83 per cent of the evaluators did not plan to monitor menus at their sites and had no formal training in dietetics or nutrition. Eighty-four per cent were able to plan menus satisfactorily after this brief introduction. The younger evaluators with more education grasped the concepts faster and were able to plan menus with greater accuracy. The data also indicated that previous experience in menu planning enhanced their ability to plan NSMs. Most felt the approach to be workable and applicable. Menu monitoring was more difficult for the evaluators. Seventy-five per cent were able to monitor menus satisfactorily, and all felt they could do so with more time. The data again showed that the younger individuals having more formal education were able to master the monitoring skills more easily.

Adult↗
PubMed1983

ASHP guidelines for pharmacist participation in home parenteral nutrition programs.

Pharmacists must make their own decisions as to whether they elect to participate in HPN programs. They need to determine the financial, social, and professional impact of an HPN program upon their institution. They need to consider the availability of these services from other hospitals or through private providers of home-health care. These guidelines are intended to help pharmacists make these decisions.

Home Nursing↗
PubMed2006

Fortifying milk with ferrous gluconate and zinc oxide in a public nutrition program reduced the prevalence of anemia in toddlers.

We aimed to assess the efficacy of whole cow's milk fortified with ferrous gluconate and zinc oxide, along with ascorbic acid, in reducing the prevalence of anemia and improving iron status of low income children 10-30 mo of age. Healthy children were randomly assigned to drink 400 mL/d of cow's whole milk, either fortified milk (FM) with 5.8 mg/400 mL of iron as ferrous gluconate, 5.28 mg/400 mL of zinc as zinc oxide, and 48 mg/400 mL of ascorbic acid, or nonfortified milk (NFM) with 0.2 mg iron/400 mL, 1.9 mg zinc/400 mL, and 6.8 mg ascorbic acid/400 mL. Hemoglobin, serum ferritin, soluble transferrin receptors (TfR), and C-reactive protein concentrations were measured at baseline and 6 mo after intervention. The prevalence of anemia declined from 41.4 to 12.1% (P < 0.001), or 29 percentage points, in the FM group; there was no change in the NFM group. Hemoglobin (coefficient = 0.22, P < 0.01) was positively and TfR (coefficient = -0.29, P < 0.001) negatively associated with treatment, controlling for their respective baseline values, age, and gender. Treatment with FM was negatively associated with the likelihood of being anemic (pseudo R(2) = 0.085, P < 0.03) after 6 mo of intervention. Ferrous gluconate added to whole cow's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status of Mexican toddlers. The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1-11 y of age in Mexico.

Anemia, Iron-Deficiency↗
PubMed1977

[Community health aide. Critical estimation of his task within the nutrition program].

Community Health Aides (CHA), locally recruited and trained, visit households and identify malnourished children by means of weighing them in monthly intervals, recording the results on "Gomez" weight-for-age charts. The CHA acts as the people's nearest adviser. In order to become a useful if not the most important member of the health team, some common mistakes and distorted views should be corrected early in her career. The weight-for-age chart is an invaluable tool to record the child's state of health. It is the trend in weight gain that is relevant and not an isolated weight point on the graph. Maternal, perinatal and neonatal histories should be taken as they help to classify the low weight child. 3/4 of the children in the Young Child Nutrition Programme (YCNP) are underweight but also underheight for age. The designation of malnutrition grade I/II/III is misleading. Either one speaks of "undernutrition" if one considers weight-for-age only or one takes other anthropometric measurements such as the height or length in order to classify Protein-Energy-Malnutrition. A physical examination and clinical records are essential in the evaluation of malnutrition - one should not rely on the graph only. By measuring the height of children, one may well be surprised to discover that many children in St. James are on the obese side. Obesity is another form of malnutrition prevalent in the wealthy societies of western industrialized countries. It is paradox that we should increase the number of obese people in a world which is threatened by shortage of food energies and proteins.

Age Factors↗
PubMed2003

Physical activity and nutrition programs for couples: a randomized controlled trial.

Diet and physical activity habits may deteriorate after cohabitation, leading to weight gain and increased risk of lifestyle diseases. We carried out a 4-month, randomized controlled trial of a diet and physical activity program for couples with a 1-year follow-up, comparing two methods of delivery. The program used six modules, which, after an initial group session, were mailed to the low-level intervention group. In the high-level intervention group, half of the modules were mailed, and the others were delivered at interactive group sessions. A control group received no intervention. Postintervention and at follow-up, physical fitness improved in the high-level group, saturated fat intake decreased in both intervention groups, and low-density lipoprotein cholesterol fell in the high-level group. Fewer participants in the high-level group became overweight or obese. Health promotion for couples can improve health behaviors and potentially lower the risk of lifestyle diseases in participants and their future families.

Adolescent↗
PubMed2002

Predictors of breastfeeding duration for employees of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

During the past decade there has been increasing breastfeeding support within the Women, Infants, and Children (WIC) program. For this study, it was hypothesized that employees at WIC would initiate and continue to breastfeed significantly longer than the National averages. Female employees, mostly paraprofessionals, from six Los Angeles County WIC agencies participated in the study to determine breastfeeding rates and predictors of breastfeeding success. As expected, 99% of WIC employees initiated breastfeeding and 68.6% continued to breastfeed to one year, significantly exceeding National averages. Four variables accounted for 30% of the variance in duration of breastfeeding: intent to exclusively breastfeed, delayed introduction of infant formula, attendance at breastfeeding support groups and availability of work-site breastpumps. Given that nearly 70% of the study participants reached the American Academy of Pediatrics goal of breastfeeding to 12 months or more, it is clear that full-time employment and breastfeeding can be compatible given appropriate work-site support.

Adult↗
PubMed1981

Nutrient intake, adiposity, plasma total cholesterol, and blood pressure of rural participants in the (Vermont) Nutrition Program for Older Americans (Title III).

The interrelationships of obesity, hypertension, elevated plasma cholesterol (risk factors), and intakes of selected nutrients were examined among elderly subjects attending a congregate meal program in Vermont. Mean nutrient intakes were significantly higher for 22 males compared to 69 females. Mean plasma cholesterol levels were higher in females. Age, systolic and diastolic blood pressure, and indices of adiposity showed no sex differences. Intakes of total fat and animal protein increased in males but plasma cholesterol decreased with age. Systolic blood pressure in females increased while body mass index decreased with age. A higher proportion of females had plasma cholesterol levels greater than or equal 260 mg/100 ml and a higher proportion of females than males greater than 73 yr of age had blood pressures at risk level. There was a greater proportion of females than males with both elevated plasma cholesterol levels and adiposity. Similarly the females had greater incidence of the combination of any two risks. No males, compared to 9% of females, were in the all three risk category.

Aged↗
PubMed2005

Ontogeny and nutritional programming of adiposity in sheep: potential role of glucocorticoid action and uncoupling protein-2.

Increased glucocorticoid action and adipose tissue inflammation contribute to excess adiposity. These adaptations may be enhanced in offspring exposed to nutrient restriction (NR) in utero, thereby increasing their susceptibility to later obesity. We therefore determined the developmental ontogeny of glucocorticoid receptor (GR), 11beta-hydroxysteroid dehydrogenase (11betaHSD) types 1 and 2, and uncoupling protein (UCP)-2 mRNA in perirenal adipose tissue between late gestation and 6 mo after birth in the sheep, as well as the effect of maternal NR targeted between early to mid (28-80 days, term approximately 147 days)- or late (110-147 days) gestation. GR and 11betaHSD1 mRNA increased with fat mass and were all maximal within the 6-mo observation period. 11betaHSD2 mRNA abundance demonstrated a converse decline, whereas UCP2 peaked at 30 days. GR and 11betaHSD1 mRNA abundance were strongly correlated with total and relative perirenal adipose tissue weight, and UCP2 was strongly correlated with GR and 11betaHSD1 mRNA. Early- to midgestational NR increased GR, 11betaHSD1, and UCP2 mRNA, but decreased 11betaHSD2 mRNA abundance, an adaptation reversed with late-gestational NR. We conclude that the continual rise in glucocorticoid action and fat mass after birth may underlie the development of later obesity. The magnitude of this adaptation is partly dependent on maternal food intake through pregnancy.

11-beta-Hydroxysteroid Dehydrogenase Type 1↗
PubMed2005

Maternal nutritional programming of fetal adipose tissue development: long-term consequences for later obesity.

As obesity reaches epidemic levels in the United States there is an urgent need to understand the developmental pathways leading to this condition. Obesity increases the risk of hypertension and diabetes, symptoms of which are being seen with increased incidence in children. Adipocyte development begins in the fetus and, in contrast to all other tissues whose growth ceases in late juvenile life, it has the capacity for "unlimited" growth. In normal healthy individuals, the increase in fat mass with age is accompanied by a parallel increase in cortisol sensitivity, i.e., increased glucocorticoid receptor abundance and increased activity of the enzyme 11beta hydroxysteroid dehydrogenase type 1. Enhanced adipocyte sensitivity to cortisol is promoted in offspring born to mothers that were nutrient-restricted in utero in conjunction with increased peroxisome proliferator activated receptor alpha. This adaptation only appears to be associated with greater fat mass in the offspring when maternal nutrient restriction is confined to late gestation, coincident with the period of maximal fetal growth. In these offspring, increased fat mass is accompanied by glucose intolerance and insulin resistance, in conjunction with an adipose tissue specific reduction in glucose transporter 4 abundance. In conclusion, changes in maternal and, therefore, fetal nutrient supply at specific stages of gestation have the potential to substantially increase the risk of those offspring becoming obese in later life. The extent to which changes in dietary habits, both during pregnancy and in later life, may act to contribute to the current explosion in childhood and adult obesity remains a scientific and public health challenge to us all.

Adipocytes↗
PubMedDate not supplied

Human embryonic stem cells as a model for nutritional programming: an evaluation.

Our laboratory is evaluating whether an epigenetic mechanism involving alterations in DNA methylation can alter the trajectory of embryonic/fetal development in response to maternal nutrients. A similar mechanism may operate in embryo culture environments commonly used in human assisted conception. Since developmental studies on early human embryos in utero are obviously not possible, we have begun to investigate the utility of human embryonic stem cells (hESC) to uncover potential programming mechanisms. This review highlights some of the advantages and problems associated with such a model and suggests that these issues are also broadly applicable to utility of hESC for more general toxicology and drug screening applications.

Adult↗