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Multiple perspectives on nutrition education needs of low-income Hispanics.

As part of a multi-level nutrition intervention for low-income Hispanics (LIH) and the professionals and paraprofessionals who serve them, focus groups were used to 1) identify nutrition education needs and preferred means of receiving nutrition information, 2) identify the LIH's barriers/motivators to dietary behavior change, and 3) assess the feasibility of using abuelas (Hispanic grandmothers) as educators. Nine focus groups were conducted using trained, local bilingual and bicultural moderators. Low-income Hispanics' primary concerns were their children's nutritional habits and ways to prepare quick, nutritious meals and snacks. Their major barriers to dietary change were financial limitations, lack of time, and family customs/habits. Professionals were concerned with the lack of interagency cooperation. Paraprofessionals were most interested in training on how to teach. All audiences preferred to receive nutrition education through classes with hands-on, interactive formats. Professionals and paraprofessionals noted advantages and disadvantages to using abuelas as educators. Including three populations in the needs assessment allowed comparisons of perspectives across groups and allowed the design of nutrition education programs appropriately targeted to these populations.

Child↗

Peer interaction and loneliness in high-functioning children with autism.

Social interaction with peers and the understanding and feelings of loneliness were examined in 18 high-functioning children with autism and 17 typically developing children matched for IQ, chronological age, gender, and maternal education. Observations were conducted on children's spontaneous social initiations and responses to their peers in natural settings such as recess and snack time, and children reported on their understanding and feelings of loneliness and social interaction. Overall, children with autism revealed a good understanding of both social interaction and loneliness, and they demonstrated a high level of social initiation. However, they spent only half the time in social interactions with peers compared with their matched counterparts, and they interacted more often with a typically developing child than with another special education child. Despite the intergroup differences in frequency of interaction, a similar distribution of interactions emerged for both groups, who presented mostly positive social behaviors, fewer low-level behaviors, and very infrequent negative behaviors. Children with autism reported higher degrees of loneliness than their typical age-mates, as well as a lower association between social interaction and loneliness, suggesting their poorer understanding of the relations between loneliness and social interaction. Research and practice implications of these findings are discussed.

Adolescent↗

Teaching VOCA use as a communicative repair strategy.

Students with developmental disabilities often rely on prelinguistic behavior (e.g., reaching, leading) to communicate. When listeners fail to attend to prelinguistic behaviors, students may benefit from responding with an alternative form of communication to repair the breakdown. In the present study, we taught two students with developmental disabilities to repair communicative breakdowns by using a voice-output communication aid (VOCA). Intervention occurred at morning snack time when the students had the opportunity to access preferred items through prelinguistic behavior (e.g., reaching, guiding). Breakdowns occurred when the listener failed to attend to the student's initial request. Effects of the intervention were evaluated in a multiple-baseline design across subjects. Both students learned to use the VOCA to repair communicative breakdowns. As VOCA use was acquired as a repair strategy, the students also began to use the device to initiate requests when there had been no breakdown in communication. The intervention appeared to be an effective approach for supplementing prelinguistic behaviors with an additional option for communicating a request.

Adolescent↗

Evaluation of a Five-A-Day recipe booklet for enhancing the use of fruits and vegetables in low-income households.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) needs to evaluate appropriate nutrition education for its at risk audience, including Five-A-Day for Better Health educational material that promotes consumption of five servings a day of fruits and vegetables. An evaluation was conducted of a Five-A-Day recipe booklet for use with mothers having a child or children enrolled in WIC. Three clinic sites in eastern Washington State tested the booklet using a pretest (n = 225)/post-test (n = 167) design and an intervention protocol based on preliminary focus group data. The booklet featured information on fresh produce and was accordingly tested over the summer months. Participants were on average 28 years of age and mostly White (77%). After receiving the booklet, many WIC mothers reported feeling more confident about choosing good quality fresh produce (70%) and storing fruits and vegetables appropriately (68%), and also felt that it was easier to include fruits and vegetables in their family's meals (74%). Many mothers reportedly served more fruits and vegetables to their families after receiving the booklet. Notably, this occurred at numerous meals and snack times with both fruits and vegetables, and was independent of a reported trend to consume more fruits and vegetables in the summer. Mothers also favorably evaluated the format and content of the booklet. However, mothers' barriers related to fruits and vegetables did not change, and their estimated intake of fruits and vegetables decreased slightly over the intervention period. Adjustments to the protocol are suggested that may enhance the booklet's effect on WIC mothers' attitudes and behaviors.

Adult↗

Dietary factors and body mass index in a group of Iranian adolescents: Tehran lipid and glucose study--2.

OBJECTIVE: To study the prevalence of overweight and obesity in an adolescent population in Tehran and to determine possible association with energy and nutrient intake and distribution of energy over the day. METHOD: A cross-sectional study on 177 boys and 244 girls between 10-19 years old was performed. Overweight and obesity were defined by using recommended body mass index (BMI) cut-off values for adolescents. Total energy intake, percent of energy derived from protein, carbohydrate and fat and percent of energy supplied by each meal and snack were assessed by means of two 24-hour dietary recalls. RESULTS: Prevalence of overweight and obesity was 10.7 and 5.1 in boys and 18.4 and 2.8 in girls, respectively. The composition of diet was not different between overweight/obese and normal weight subjects. BMI was related with breakfast energy percentage in girls (r = -0.18, p < 0.01), with total energy intake in boys (r = 0.23, p < 0.01), and with lunch energy percentage in both sexes. In boys (r = 0.16, p < 0.05) and in girls (r = 0.22, p < 0.01). CONCLUSION: High prevalence of overweight and obesity among adolescents was seen. In boys some relationship between total energy intake, distribution of energy over the day and BMI was seen. In girls BMI was only related with distribution of energy over the day.

Adolescent↗

Influence of maternal education on food consumption and energy and nutrient intake in a group of pre-school children from Madrid.

A study was conducted on the influence of maternal education level on food consumption, energy and nutrient intake, and dietary adequacy in 110 pre-school children from Madrid, Spain. With increasing maternal education, children consumed more sugar(p < 0.05), fruit (p < 0.05), and fish (p < 0.05). Snacking was more frequent with decreasing maternal education (p < 0.05). Though statistical significance was not reached, the consumption of pre-cooked foods was greater among children of mothers educated to a higher level, a phenomenon probably related to the work situation of these women. With respect to dietary composition, no significant differences were found between groups for macronutrient, fiber and energy intakes, except for energy supplied by polyunsaturated fatty acids (PUFA), which was greater in the children of less educated women (p < 0.01). This is probably due to their greater consumption of sunflower seed oil. The diets of children belonging to well-educated mothers came closer to meeting the recommended intakes for folate, vitamin C, and iodine. It would seem that maternal educational level influences the food habits of children. Mothers with less education may require special advice in this area.

Adult↗

Fruit and vegetable consumption among Turkish university students.

A questionnaire was developed to determine the behaviors associated with eating fruit and vegetables and to assess perceived benefits and barriers to increasing fruit and vegetable consumption. A total of 713 non-food/nutrition major university students were randomly selected from seven universities in Turkey. Self-reported mean intake was found to be 3.67+/-1.81 servings of fruit and vegetables per day. Positive correlations existed between daily fruit and vegetable portions. Male students were significantly higher than female students in body mass index measurements (BMI 22.71 vs. 20.1, p < or = .05). Among male students only BMI was positively associated with age. Compared to male students, female students were more likely to eat fruit and vegetables. Male students were less likely to eat fruit instead of dessert. Vegetables were more preferred by female students at lunch and dinner. Exploratory principal-components analyses showed that a two-component solution best represented the data. The first component represented the benefits of eating more fruit. The second component described barriers to eating more fruit. Both components have an internal consistency of 0.73 and 0.56 respectively, with benefits accounting for 17% and barriers 12% of variance These scales may be used to increase the benefits to get students to think about change, and decreasing the barriers to allow the behavior to change in fruit and vegetable consumption should follow this. Since Turkish students do not eat enough fruit and vegetables, nutrition education efforts must be targeted at students (i.e. acceptability of these foods in different meal and snacks is maintained, promoted, and encouraged). Barriers may be reduced, thereby allowing students to take action and maintain the behavior change.

Adult↗

Beer-induced anaphylaxis: identification of allergens.

BACKGROUND: We report on a 21-year-old atopic woman who developed urticaria, angioedema of the face, and wheezy dyspnea shortly after drinking beer and after eating a corn-made snack. METHODS: Skin prick tests and specific IgE determinations to beer ingredients and cereal extracts were performed. Immunoblotting inhibition assays were carried out to investigate possible common allergens shared by barley and malt with corn. RESULTS: Skin prick tests and specific IgE measurements with beer, barley, malt, wheat, corn, rye, rice, and oat flour were positive. Ten pollen-allergic patients showed negative skin tests to beer. Double-blind, placebo-controlled, oral challenge tests with sodium metabisulfite and wheat flour were negative. Immunoblotting demonstrated several IgE-binding bands at 31-56 kDa in malt and barley extracts, and a major band at 38 kDa in the beer extract. Immunoblot inhibition assays showed that malt extract was able to inhibit most of the IgE-binding bands in wheat and corn extracts, whereas corn did not produce significant inhibition to barley and malt extracts. CONCLUSIONS: This patient developed type I hypersensitivity to barley/malt and corn. Although she also showed IgE reactivity to wheat and other cereals, no symptoms were elicited upon ingestion of these cereals, probably indicating latent sensitization to them.

Administration, Oral↗

Hidden peanut allergens detected in various foods: findings and legal measures.

BACKGROUND: Undeclared allergens in foodstuffs represent a major health problem for sensitized persons. Until recently, most food control authorities were not in the position to monitor hidden allergens and to take legal measures against their presence in foodstuffs. METHODS: In this study, we employed human sera-based immunoassay techniques, enabling semiquantitative detection and identification of peanut allergens in a variety of foodstuffs. RESULTS: This study showed the presence of undeclared allergens in products belonging to various food categories, such as cereals, cookies, cakes, and snacks. The detection limit for peanut contamination was in most instances less than 50 mg peanut material per kg, i.e., less than about 5 mg peanut allergens per kg. We legally objected to products with more than one part per thousand or 1000 mg/kg of peanut contamination. CONCLUSIONS: In most cases, food producers, confronted with our results, were able to detect and eliminate the sources of the contamination. They implemented measures to prevent the presence of hidden peanut allergens in their products, increasing food safety for sensitized persons and overall food quality.

Allergens↗

Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6- to 36-month-old children.

UNLABELLED: Caufield et al. (1) have suggested that the acquisition of mutans streptococci in young children most likely takes place during a "window of infectivity" from 19 to 31 months of age. OBJECTIVES AND METHODS: This study determined the prevalence of dental caries and bacterial infection in a randomly selected sample of 199 children 6 to 36 months old from the island of Saipan in the Common-wealth of the Northern Mariana Islands, USA. The relationships between caries and Streptococcus mutans infection, hypoplasia, diet and oral hygiene behavior were investigated. RESULTS AND CONCLUSIONS: The overall estimated prevalence of caries was high: 46.8% of the children had white spot lesions and 39.1% had enamel cavitation. Colonization was seen in very young children; S. mutans was detected in 25% of the predentate children. The results of multi-variable modeling support the hypothesis that bacterial infection, diet, and hypoplasia are important in the etiology of dental caries in this population. Adjusted for age and ethnicity, children with a high level of S. mutans detected were 5 times more likely to have dental caries than children with a lower level of S. mutans detected. Hypoplasia and a high cariogenicity score (diet) were also significant independent predictors. The odds of having any white spot lesions or enamel cavitation were 9.6 times greater for children with any hypoplasia, and 7.8 times greater for children with high cariogenicity scores relative to those with lower scores after adjusting for level of S. mutans, age and ethnicity. Sleeping with a bottle, maternal sharing of utensils, and high snacking frequency were not significant predictors of caries in this population.

Analysis of Variance↗

Early childhood caries in northern Philippines.

OBJECTIVES: To determine prevalence and severity of early childhood caries (ECC) among children in northern Philippines. Further, to describe and determine the impact of child-rearing practices and dental visits on caries status. METHODS: Cross-sectional survey of 993 children aged 2-6 years. Caries was diagnosed based on WHO recommendations. Additional behavioral information was obtained from 452 children aged 3-6 years. RESULTS: Caries prevalence and mean dmft (+/-SD) by age were as follows: 2 years = 59% (4.2 +/- 5.3); 3 years = 85% (7.4 +/- 5.5); 4 years = 90% (8.8 +/- 5.6); 5 years = 94% (9.8 +/- 5.5); and 6 years = 92% (10.1 +/- 5.5). Caries rates mirrored those of developing countries with untreated lesions dominating all ages. Mixed breast and bottle feeding was the norm. Almost half were weaned at more than 2 years old. Majority had toothbrushing practices, but mostly without parental assistance. Toothbrushing was initiated at an average age of 2 years. Only a small proportion had a dental visit, mostly for emergency reasons. Among 3-4-year-old children, a significant increase in caries levels were noted for those who started brushing at a later age, had frequent snacks, and had a dental visit for emergency reasons. For children aged 5-6 years, those who went for emergency visits also had significantly more caries. Results indicated an urgent need to (i) increase awareness that ECC is a public health problem in these areas, (ii) advocate use of fluoride as a public health measure, and (iii) increase access to preventive dental services for preschool children.

Age Factors↗

Family members' preferences for nutrition interventions to improve nursing home residents' oral food and fluid intake.

OBJECTIVES: To measure family members' preferences for nutrition interventions to improve the oral food and fluid intake of their relatives in a nursing home. DESIGN: Cross-sectional descriptive. SETTING: Three skilled nursing facilities in Southern California. PARTICIPANTS: One hundred five residents from the three skilled nursing facilities and their respective family members. MEASUREMENTS: A mailed questionnaire to family members that consisted of 15 forced-choice comparisons between six nutrition interventions. An assessment of oral food and fluid intake during mealtime for 3 days (nine meals) for each participant using direct observations and estimations of percentage consumed (0% to 100%) by trained research staff. RESULTS: In order of most to least desirable, the family members preferred the following interventions to improve their relative's oral food and fluid intake: (1) improve quality of food; (2) improve quality and quantity of feeding assistance; (3) provide multiple small meals and snacks throughout the day; (4) place resident in preferred dining location; (5) provide an oral liquid nutritional supplement between meals; and (6) provide a medication to stimulate appetite. The average +/- standard deviation total percentage intake for residents whose family members reported that they thought their relative had a problem with their intake was 50%+/- 16%. CONCLUSIONS: Family members prefer that other nutrition interventions be attempted before the use of oral supplements or pharmacological approaches. Family members perceive a need for interventions when residents consume, on average, only half of the food and fluid items provided during mealtime.

Aged↗

Weight gain and withdrawal symptoms after smoking cessation: a preventive intervention using d-fenfluramine.

Directly measured food intake in 31 overweight female smokers to test whether (a) calorie and carbohydrate intakes increase after smoking cessation and (b) double-blind d-fenfluramine (30 mg), a serotonin-releasing drug, suppresses weight gain, overeating, and dysphoric mood associated with stopping smoking. Placebo-treated patients grew dysphoric after smoking withdrawal and ate 300 kcal/day more from 2 to 28 days after, showing a 3.5-lb weight gain. Fat and protein intakes did not change, but carbohydrate intake increased (30% to 40%). D-fenfluramine prevented postcessation dysphoria. Although drug-treated patients ate more carbohydrate snacks just after quitting, they returned to baseline by 4 weeks, showing a 1.8-lb weight loss. Agents that enhance brain serotonin-mediated neurotransmission may help prevent weight gain, overeating, and dysphoric mood after smoking withdrawal.

Adult↗

The role of gender and taste class in the effects of stress on eating.

Participating in a laboratory study of the effects of stress on eating, healthy, nonsmoking men and women were shown a film about industrial accidents (stress condition) or a pleasant travelogue (control condition) and had access to sweet, salty, and bland snack food. Analyses of food consumption data revealed a significant interaction between sex of subject and the stress manipulation: Stress markedly and significantly decreased food consumption by men but resulted in some increased food consumption by women. Across the three food taste categories, men consistently ate less under stress than they did in the control condition. In contrast, women ate nearly twice as much sweet food and more bland food under stress than they did in the control condition, but these effects were not statistically significant. These results indicate that the relationship between stress and eating depends on the sex of the subject and may relate to type of food available. Contrasting generalizations about stress and eating reported in the archived literature can largely be reconciled by considering these interacting variables.

Adult↗

Effects of tobacco abstinence on food intake among cigarette smokers.

The total caloric and specific nutrient intakes of smokers who became abstinent were compared with those of a control group. Both groups were composed of volunteer inpatients housed in a research ward for 7 days. After smoking ad libitum for 3 days, the experimental group was required to abstain from tobacco for the next 4 days while the control group continued to smoke. Significant increases in total caloric intake and in grams of carbohydrates, protein, fat, and sucrose were observed in the experimental relative to the control group, whereas no significant differences were found in fructose intake. The increase in caloric intake was not specific to increases in snacking. Preliminary analyses showed gender differences in food intake as a result of tobacco abstinence.

Adult↗

Dieting behaviors and weight change history in female adolescents.

The prevalence of dieting, weight change history, and specific weight loss behaviors was examined in a population-based sample of 1,015 female 9th-12th graders. Healthy weight loss behaviors were reported much more frequently than unhealthy weight loss behaviors (e.g., healthy behaviors: exercise = 32.4%, decrease fat intake = 26.0%, reduce snacks = 25.0%, reduce kilocalorie intake = 22.4%; unhealthy behaviors: fasting = 8.1%, diet pills = 5.4%, vomiting = 4.4%). Obesity status and restrained eating scores were positively related to greater history of weight loss episodes, pounds lost, and weight fluctuations and to greater use of healthy weight loss methods and weight loss programs. Implications for public health recommendations regarding dieting and its associated behaviors in female adolescents are discussed.

Adolescent↗

Effects of simultaneous oral-intragastric ingestion on meal patterns and satiety in humans.

Simultaneous oral-intragastric ingestion of a liquid diet was compared with oral ingestion for 15-21 days in four males or normal weight, 18-21 years old. All the subjects are significantly more (M= 222 cm3 or kcal [930 kJ] per meal, p less than .025) during simultaneous compared with oral lunches and dinners. Subjects reduced the size and frequency of breakfasts and snacks, which were always ingested orally, however, and did not gain weight. In a second experiment, the same four subjects ate significantly more (M-177 cm3 more, p less than .001 at lunch when the rate of ingestion was 200 cm3/min compared with 100 cm3/min regardless of route (oral, intragastric or simultaneous). They also ate significantly more (M=135 cm3 more, p less than 0.25) during simultaneous meals compared with oral or intragastric meals ingested at the same rate. Thus, rate of ingestion and oral stimulation are important determinants of meal size in humans.

Administration, Oral↗

An experimental model for assessing effects of anorectics on spontaneous food intake of obese subjects.

Ad libitum access to food by use of a platter service is a new method for studying spontaneous food intake in obese human subjects. The effect of diethylpropion on energy intake was evaluated by the platter-service method in 2 overweight adult male subjects hospitalized on a metabolic unit for 41 days. This double-blind experiment was divided into 12 consecutive 3-day study periods during each of which the subjects received either 25 mg diethylpropion or a matching placebo before each meal. In this design protocol the 12 study periods provided 6 consecutive drug-placebo trials for each subject. To encourage ad libitum ingestion, food was served "family style" from large platters and pitchers at meals, and snacks were always available. Subjects were not aware that their intake was being monitored. On diethylpropion administration both subjects had an average decrease in energy intake of 11% and 15% (p less than 0.005). The platter service model, which provides a near-natural eating situation under systematic control, appears to be a useful and sensitive method for assessing effects of anorectic drugs on spontaneous food intake.

Adult↗