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PubMed1978

School nutrition programs in perspective.

From a meager beginning with the passage in 1946 of the initial National School Lunch Act, school nutrition programs have grown until today they are "big business," employing some 350,000 persons in more than 89,000 units, and representing more than $1 billion in volume. As programs have expanded, the need for more professionalism in the field has been felt, and a number of educational and certifying programs have emerged. A new aspect, just being implemented as a result of 1977 legislation, is the nutrition education facet implicit in serving school meals. A driving force in meeting nutritional goals of school foodservice programs is the American School Food Service Association, an organization of some 67,000 members.

Child↗
PubMed2004

Special Supplemental Nutrition Program for Women, Infants, and Children participation and infants' growth and health: a multisite surveillance study.

CONTEXT: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7 500 000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security. OBJECTIVE: To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants < or =12 months of age, at 6 urban hospitals and clinics. DESIGN AND SETTING: A multisite study with cross-sectional surveys administered at urban medical centers in 5 states and Washington, DC, from August 1998 though December 2001. PARTICIPANTS: A total of 5923 WIC-eligible caregivers of infants < or =12 months of age were interviewed at hospital clinics and emergency departments. MAIN OUTCOME MEASURES: Weight-for-age, length-for-age, weight-for-length, caregiver's perception of infant's health, and household food security. RESULTS: Ninety-one percent of WIC-eligible families were receiving WIC assistance. Of the eligible families not receiving WIC assistance, 64% reported access problems and 36% denied a need for WIC. The weight and length of WIC assistance recipients, adjusted for age and gender, were consistent with national normative values. With control for potential confounding family variables (site, housing subsidy, employment status, education, and receipt of food stamps or Temporary Assistance for Needy Families) and infant variables (race/ethnicity, birth weight, months breastfed, and age), infants who did not receive WIC assistance because of access problems were more likely to be underweight (weight-for-age z score = -0.23 vs 0.009), short (length-for-age z score = -0.23 vs -0.02), and perceived as having fair or poor health (adjusted odds ratio: 1.92; 95% confidence interval: 1.29-2.87), compared with WIC assistance recipients. Rates of overweight, based on weight-for-length of >95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants' weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance. CONCLUSIONS: Infants < or =12 months of age benefit from WIC participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.

Body Height↗
PubMed1994

Working with professional athletes in the rink: the evolution of a nutrition program for an NHL team.

For many professional sports, nutrition is not recognized as an important component of the team's training program. The implementation of a nutrition program for one professional hockey team has had positive results. Players who had been unable to maintain their weight during the season can now maintain their weight and be prepared for the playoffs. Others have improved their endurance with proper fluid and carbohydrate replacement. Working with the entire time--coaching staff, trainers and players--has led to the success of this program.

Counseling↗
PubMed2004

Building beef cow nutritional programs with the 1996 NRC beef cattle requirements model.

Designing a sound cow-calf nutritional program requires knowledge of nutrient requirements, diet quality, and intake. Effectively using the NRC (1996) beef cattle requirements model (1996NRC) also requires knowledge of dietary degradable intake protein (DIP) and microbial efficiency. Objectives of this paper are to 1) describe a framework in which 1996NRC-applicable data can be generated, 2) describe seasonal changes in nutrients on native range, 3) use the 1996NRC to predict nutrient balance for cattle grazing these forages, and 4) make recommendations for using the 1996NRC for forage-fed cattle. Extrusa samples were collected over 2 yr on native upland range and subirrigated meadow in the Nebraska Sandhills. Samples were analyzed for CP, in vitro OM digestibility (IVOMD), and DIP. Regression equations to predict nutrients were developed from these data. The 1996NRC was used to predict nutrient balances based on the dietary nutrient analyses. Recommendations for model users were also developed. On subirrigated meadow, CP and IVOMD increased rapidly during March and April. On native range, CP and IVOMD increased from April through June but decreased rapidly from August through September. Degradable intake protein (DM basis) followed trends similar to CP for both native range and subirrigated meadow. Predicted nutrient balances for spring- and summer-calving cows agreed with reported values in the literature, provided that IVOMD values were converted to DE before use in the model (1.07 x IVOMD - 8.13). When the IVOMD-to-DE conversion was not used, the model gave unrealistically high NE(m) balances. To effectively use the 1996NRC to estimate protein requirements, users should focus on three key estimates: DIP, microbial efficiency, and TDN intake. Consequently, efforts should be focused on adequately describing seasonal changes in forage nutrient content. In order to increase use of the 1996NRC, research is needed in the following areas: 1) cost-effective and accurate commercial laboratory procedures to estimate DIP, 2) reliable estimates or indicators of microbial efficiency for various forage types and qualities, 3) improved estimates of dietary TDN for forage-based diets, 4) validation work to improve estimates of DIP and MP requirements, and 5) incorporation of nitrogen recycling estimates.

Animal Nutritional Physiological Phenomena↗
PubMed1981

Parenteral nutrition program in a major cancer center.

In this article, formulation ordering, manufacturing procedures, and the quality control techniques utilized by the parenteral nutrition program at Memorial Sloan-Kettering Cancer Center are described. The cancer patient's metabolic status frequently changes; therefore, individualized prescriptions are used for all parenteral nutrition solutions. Due to the cancer patient's high risk of infection, related to disease-induced or iatrogenic immunosuppression, strict attention to aseptic procedures is required, including personnel wearing disposable gowns, head and shoe coverings, face masks, and surgical gloves. Specific emphasis has been placed on maximal cost effectiveness in manufacturing protocols. Preparation of solutions is, however, only one component of the role played by the pharmacists on the nutrition team. We describe the clinical responsibilities which are of paramount importance, since medications and other treatment modalities can markedly alter nutritional status and electrolyte balance. Monitoring the medications a patient receives and carefully watching a patient's laboratory results are important functions of the pharmacist. For the cancer patient, particular emphasis must be placed on nutritional and metabolic aberrations caused by antibiotics, corticosteroids, diuretics, antineoplastic agents, and narcotic analgesics. Radiation therapy can result in serious physiologic and nutritional effects. An innovative patient profile for monitoring a cancer patient receiving parenteral nutrition is introduced. The pharmacists are also involved in several teaching programs and a new outpatient program for administration of I.V. antibiotics to selected home total parenteral nutrition patients.

Cancer Care Facilities↗
PubMed2002

Design of a prospective, randomized evaluation of an integrated nutrition program in rural Viet Nam.

Few prospective studies of child growth and its determinants take place in programmatic contexts. We evaluated the effect of Save the Children's (SC) community empowerment and nutrition program (CENP) on child growth, care, morbidity, empowerment, and behavioral determinants. This paper describes the research methods of this community-based study. We used a longitudinal, prospective, randomized design. We selected 12 impoverished communes with documented child malnutrition, three comparison, and three intervention communes in each of two districts in Phu Tho Province, west of Hanoi. SC taught district trainers in November 1999 to train local health volunteers to implement the 10-month CENP, including situation analysis, positive deviance (PD) inquiry, growth monitoring and promotion, nutrition education and rehabilitation program (NERP), deworming, and monitoring. PD inquiries aim to discover successful care practices in poor households that likely promote well-nourished children. NERPs are neighborhood-based, facilitated group learning sessions where caregivers of malnourished children learn and practice PD and other healthy behaviors. We dewormed all intervention and comparison children. We randomly selected 240 children 5 to 25 months of age (120 intervention and 120 comparison). We gathered information on nutritional status, diet, illness, care, behavioral determinants, empowerment, and program quality, monthly for six months with a re-survey at 12 months. We collected most information through maternal interview but also observed hygiene and program quality, and videotaped feedings at home. Some implementation and research limitations will attenuate CENP impact and measurement of its effectiveness.

Child Nutrition Disorders↗
PubMed2004

Reaching out to racial/ethnic minority older persons for elderly nutrition programs.

This paper reports findings from a study that was conducted to identify perceived barriers to racial/ethnic minority elders' participation in an elderly nutrition program (ENP) in a large metropolitan area and effective strategies for reaching out to them. The data were collected from a survey with the ENP's staff and volunteers and three focus group discussions with professionals working with minority elders and minority community leaders. The study participants identified as their perceived barriers: the lack of information or misinformation; culturally driven reluctance to ask for outside help; fear and distrust of formal systems; lack of ethnic menus in the program; discomfort due to cultural differences; and inaccessibility and inadequacy of transportation. Recommended outreach strategies included: involvement of family members in the information dissemination process; establishment of good working relationships with community leaders and contact with key older persons; diversification of menus and increased use of food enhancements; increase in cultural activities/programs in congregate dining centers; solicitation of input from current participants; provision of intergenerational programs; recruitment of volunteer drivers from the minority community; location of the program in ethnic enclaves or places where minority elders can easily congregate; and improvement in transportation services.

Acculturation↗
PubMed1992

Food habits and nutritional knowledge of Portuguese participants in an elderly nutrition program.

Massachusetts has the largest population of immigrant Portuguese in the United States, yet few elder service programs specifically designed to meet their needs exist. Therefore, a special nutrition program was developed in Somerville, Massachusetts to provide culturally appropriate lunches twice a week, followed by socialization activities. A survey of the participants showed that only 11% of respondents met recommended intake of dairy, protein, fruits and vegetables, as determined by the Basic Four Scoring System. The most frequently lacking food among the remaining participants were fruits and vegetables, followed by grains, as well as dairy products. The recommended protein intake was met by all but two respondents. The majority of respondents were able to identify a high sodium food, a food high in Vitamin C, a nutritionally balanced meal, and identified calcium as a necessary nutrient throughout the lifespan. Fewer respondents were able to identify foods high in protein, high in calories, and high in fiber, although their diets contained substantial amounts of these nutrients.

Aged↗
PubMed1989

[Case study: operation of a mother-child nutrition program in El Salvador].

One of the oldest international efforts in their combat of malnutrition have been the mother-child food programs (MCFP). The purpose of the study herein discussed was to detect the problems that affect the operation of the MCFP of the Ministry of Health of El Salvador, and to identify feasible measures to apply in a short term. This work analyzed the following: a) the operation of the program from the selection of the beneficiary to the delivery of the ration; b) the evolution of the beneficiaries, and c) the perception of the MCFP on mothers' part. The study covered 40 Health Services selected from all over the country; the revision of 556 children's files, and interviews to 136 mothers. It was found that the nurse is the person who plays the main role in the MCFP; that the most used criterion to enter or leave the program is the nutritional condition of the beneficiaries; that priority is given to children over pregnant women; that for most of the children there is a control kept on growth and vaccinations; and that what is mostly supervised is food handling and beneficiaries. Study of the children's files revealed that the average age of the children who enter the program is 18 months and at departure, 24 months, with a permanence of five months; and that the weight-for-age retardation when entering and leaving was similar for all the children studied, although it was different when the analysis was made by permanence and by age groups. Mothers' opinion on the MCFP permitted inference of what occurs at household levels with the donated foods; nevertheless, it is a subject that merits further study. Results of the study confirm some findings of others, although since they are specific for this Program, they allowed the appropriate decision-making for corrective measures of the MCPF.

Analysis of Variance↗
PubMed1998

Impact of a large-scale immunization initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

CONTEXT: Inner-city immunization rates have lagged behind those in other areas of the country. OBJECTIVE: To evaluate the impact of an initiative linking immunization with distribution of food vouchers in the inner city. DESIGN: Retrospective analysis of immunization data gathered in 1996 and 1997. SETTING: Nineteen Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites serving 30% of the Chicago, III, birth cohort. PARTICIPANTS: A total of 16581 children 24 months old or younger. INTERVENTIONS: Voucher incentives (varying frequency of food voucher issuance based on immunization status) and assessment of immunization status and referral to immunization provider. MAIN OUTCOME MEASURES: Age-appropriate immunization rates and WIC enrollment rates. RESULTS: During the 15-month period of evaluation, immunization rates increased from 56% to 89% at sites performing voucher incentives. The proportion of children needing voucher incentives declined from 51% to 12%. Sites performing assessment and referral, but not providing voucher incentives, showed no evidence of improvement in immunization coverage. No difference was observed in enrollment rates between sites performing voucher incentives and those that did not. CONCLUSION: Applied in a large-scale, programmatic fashion, voucher incentives in WIC can rapidly increase and sustain high childhood immunization rates in an inner-city population.

Chicago↗
PubMedDate not supplied

[Development and evaluation of food supplements for the education, health, and nutrition program].

OBJECTIVE: To develop and evaluate nutritional supplements destined to a program of social assistance. MATERIAL AND METHODS: In the design of the nutritional supplements a series of criteria were considered including nutrient composition, physicochemical properties and feasibility of production and utilization. Final products were initially evaluated to determine the level of acceptance in 40 children, 52 pregnant women and 62 lactating women in Mexico City. A community trial was also carried out to determine acceptance and consumption in 108 children and 128 women from a rural community in the state of Morelos. RESULTS: The specific formulation and technical processes of production of the nutritional supplements are presented. Products proved to be widely accepted, with average scores of 4.11-4.29 for the children's beverage, and 3.98-4.15 for a more viscous pap (range of scores was 1 to 5). Products for women received average scores from 4.75 to 5.70 in pregnant and from 4.8 to 5.4 in lactating women (range of scores from 1 to 7). In the community trial, supplements were very well accepted. Average consumption was > 75% among children and > 98% among women. Mean energy intake from supplements was 244 Kcal/day for women, and for children, 168 Kcal/day with the pap and 147 Kcal/day with the beverage. Consumption was consistent in all cases along the study. CONCLUSIONS: Nine nutritional supplements were developed and evaluated which comply with the necessary nutritional, physicochemical and hygienic characteristics for the target population, besides being relatively simple to prepare, and widely well accepted and consumed.

Adult↗
PubMed2005

Ontogeny and nutritional programming of uncoupling protein-2 and glucocorticoid receptor mRNA in the ovine lung.

This study investigated the developmental and nutritional programming of uncoupling protein-2 (UCP2), glucocorticoid receptor (GR) and 11beta-hydroxysteroid dehydrogenase type 1 (11betaHSD1) mRNA in the sheep lung from the time of uterine attachment to 6 months of age. The effect of maternal nutrient restriction on lung development was determined in early to mid gestation (i.e. 28-80 days gestation, period of maximal placental growth, and embryonic and pseudoglandular stages of fetal lung development) and late gestation (i.e. 110-147 days gestation, period of maximal fetal growth, and canalicular and saccular stages of fetal lung development). Fetal lungs were sampled at 80 and 140 days (term approximately 148 days) gestation, and sheep lungs at 1, 7, 30 days and 6 months. GR and 11betaHSD1 mRNA were maximal at 140 days gestation, whereas UCP2 mRNA peaked at 1 day of age and then declined with postnatal age. Maternal nutrient restriction in both early-to-mid and late gestation had no effect on lung weight, but increased UCP2, GR and 11betaHSD1 mRNA abundance at every sampling age. These findings suggest that the developmental ontogeny of UCP2 mRNA in the ovine lung is under local glucocorticoid hormone action and that maternal nutrient restriction has long-term consequences for UCP2 and GR mRNA abundance in the lung irrespective of its timing.

11-beta-Hydroxysteroid Dehydrogenase Type 1↗
PubMed2003

The effectiveness of assessment and referral on immunization coverage in the special supplemental nutrition program for women, infants, and children.

BACKGROUND: The use of immunization assessment and referral (A/R) in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to produce dramatic improvements in vaccination coverage when coupled with parental incentive; however, data are lacking to support the use of A/R alone. OBJECTIVE: To determine the effectiveness of A/R in increasing immunization coverage among WIC participants. DESIGN: Participating WIC centers were assigned to1 of 3 interventions that delivered A/R of varying frequency or a control group. SETTING: Twenty of the largest Public Health Foundation Enterprises-WIC centers in Los Angeles County. PARTICIPANTS: Children continuously enrolled in participating WIC centers from 6 to 24 months of age. INTERVENTION: Assessment of child's vaccination status followed by referral to a health care provider for those lacking indicated vaccinations. MAIN OUTCOME MEASURE: Up-to-date (UTD) status at 24 months of age for all recommended vaccines. RESULTS: Baseline coverage rates were similar among all study sites (overall, 77% UTD). After the study period, compared with the controls (88% UTD), we found no differences in immunization coverage among WIC centers that administered A/R at every visit (every 2 months) to all children (90% UTD; adjusted odds ratio [OR], 1.02; 95% confidence interval [CI], 0.54-1.94), every 6 months to all children (89% UTD; OR, 0.98; 95% CI, 0.62-1.56), or every visit to children found to be behind at 8 months of age (89% UTD; OR, 0.89; 95% CI, 0.48-1.68). CONCLUSION: In this urban population of WIC children with high baseline immunization coverage, A/R was not effective in increasing immunization coverage.

Child Health Services↗
PubMed1990

Comparing nutrition programs conducted by public health and Cooperative Extension personnel.

We surveyed 218 county extension agents, 75 state extension specialists, 163 public health nutritionists, and 87 public health administrators in 16 states to compare the nutrition program characteristics of extension personnel with public health personnel. Public health personnel were most strongly influenced by funding regulations--more than 80% of public health nutritionists cited infant/preschool nutrition and nutrition for pregnant/lactating women as program topics. About half of the extension agents listed food preservation and preparation as the dominant topics provided. Public health personnel most frequently designed programs for pregnant and lactating women and low-income clientele; 91% of the nutritionists ranked one-to-one counseling as one of their three most important delivery methods. Extension personnel designed programs more often for homemakers/adults and youth and ranked a combination of group and media delivery methods as most important. Public health personnel use anthropometric measures and food intake records to evaluate their programs; extension personnel use written questionnaires and program records. More than 50% of the nutritionists ranked improving the health of their clients as one of the three most important impacts of their programs; more than 50% of the extension agents ranked increasing knowledge and improving skills as their most important impacts.

Dietary Services↗
PubMed1989

Assessing productivity of foodservice systems in nutrition programs for the elderly.

A pilot study was conducted to develop a monitoring instrument for the measurement of productivity in nutrition programs for the elderly. Observations of foodservice activities were collected for 3 days in each of three senior centers utilizing cook/serve production models. Direct work activity categories included processing, service, transportation, clerical, cleaning, and receiving. Delay activities included personal delay and idle time. Information was gathered on the number of meals served. A method to recognize the equivalent work of senior citizen volunteers was developed. Productivity ratios were calculated as average labor minutes in each activity per meal served. Labor time was consistent within centers, and productivity varied with number of meals served. Average productivity ranged from 12.95 to 19.30 labor minutes per meal.

Aged↗
PubMed1978

Title VII--Nutrition Program for the Elderly. I. Contribution to one day's dietary intake.

Food records kept by 466 individuals participating in the federally funded Nutrition Program for the Elderly show that those eating at the meal site on the day of the food record consumed more energy, protein, and calcium than non-participants and participants who did not eat there on the day of the record. Dietary ratings, which included eight nutrients and energy, indicated they also had better overall diets than non-participants. Non-participants consumed more iron than participants. The daily intake of all nutrients, except calcium, of those eating at the meal site reflected what was offered. Between 40 and 50 per cent of the total daily intake was consumed at the meal center. Women consumed a significantly greater proportion of their daily intake of most nutrients from the food provided by program than the men. The desirability of providing a high proportion of the recommended allowances for protein and other nutrients through the meal program menus is emphasized. The results of the study demonstrated the importance of nutritionists in administrative roles at the state and area levels in determining the effectiveness of a meal program, since food intake reflected menu planning.

Aged↗
PubMedDate not supplied

[The participation of pharmacy services in evaluating parenteral nutrition programs].

The situation of parenteral nutrition practised in our hospital over one year was analyzed from the standpoint of Pharmacy Services, with a random sample of 26 patients with 322 days on parenteral nutrition. The most important results showed that the degree of compliance of the application sheets was 85.3%. The protocolized nutrient units were used in 80.1% of total days on parenteral nutrition, with an average of 0.97 +/- 0.60 modifications per day 855.0% electrolytes and 39.9% insulin). During the follow-up of parenteral nutrition, analytical determinations were performed every 2.3 +/- 1.8 and 4.2 +/- 2.6 days in blood and urine respectively. 30 biochemical alterations were observed, in particular hyperglycaemia (26.7%), hypoglycaemia (10%), hyperpotassemia (13.3%) and hyponatraemia (13.3%). In 70% of cases, corrective action was taken within 24 hours. The average number of multidisciplinary communications was 4.5 per patient. The initiative was taken by the pharmacist in 75.8% of cases, and the most frequent reason for communication was analysis of biochemical situation of patient and proposal for modification in daily intake.

Adult↗