Search

Food insecurity is associated with poor diet quality and increased diet-related disease risk. Food pantry clients (n=194) completed one 24-hour dietary recall and the Healthy Eating Index-2015 was used to evaluate diet quality. Differences in diet quality relative to participants’ last food pantry visit and self-reported ethnicity were evaluated using two-way ANOVA. Food pantry visits within 1–4 days compared to ≥5 days were associated with higher diet quality in non-Hispanics (p=0.01) but diet quality remained the same in Hispanics. Interventions to improve diet quality in food pantry users must consider potential ethnic differences when program planning.

Background Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by primary care professionals. Intervention Based on IH competencies developed by an interprofessional team and a needs assessment, a 32-h online interprofessional IH course, Foundations in Integrative Health, was developed. Trainees learn to conduct an IH assessment and how patients are assessed and treated from the diverse professions in integrative primary care. Methods The course was pilot-tested with educational program trainees, faculty and clinical staff at graduate level primary care training programs (primary care residencies, nursing, pharmacy, public health, behavioral health, and licensed complementary and IH programs). Outcome measures Prior to and following the course, participants completed an IH knowledge test, an IH efficacy self-assessment, and validated measures of IH attitudes, interprofessional learning, provider empathy, patient involvement, resiliency, self-care, wellness behaviors, and wellbeing. Evaluation surveys were administered following each unit and the course. Results Almost one-half (n = 461/982, 47%) completed the course. Pre/post course improvements in IH knowledge, IH self-efficacy, IH attitudes, interprofessional learning, provider empathy, resiliency, self-care, several wellness behaviors, and wellbeing were observed. The course was positively evaluated with most (93%) indicating interest in applying IH principles and that the course enhanced their educational experience (92%). Conclusion This study demonstrates the feasibility and effectiveness of a multi-site, online curriculum for introducing IH to a diverse group of primary care professionals. Primary care training programs have the ability to offer an interprofessional, IH curriculum with limited on-site faculty expertise.

Background D-limonene and its derivatives have demonstrated potential chemopreventive and anticancer activity in preclinical and clinical studies. The aim of this scoping review was to assess and critically appraise current literature on the effect of these bioactive citrus peel compounds on breast cancer in human trials and to identify knowledge gaps for exploration in future studies. Methods This study followed a scoping review framework. Peer-reviewed journal articles were included if they reported the effect of d-limonene or its derivatives on breast cancer in human subjects. Articles were retrieved from academic databases – PubMed, EMBASE, CINAHL, Web of Science, and Cochrane reviews – and iteratively through review of bibliographies of relevant manuscripts. Titles and abstracts were appraised against the aforementioned inclusion criteria in a first round of screening. Through consensus meetings and full article review by authors, a final set of studies were selected. Results were reported according to the PRISMA extension for scoping reviews. Results Our search strategy yielded 367 records. Following screening and adjudication, five articles reporting on phase 1(n = 2), phase 2 (n = 2) and both trial phases (n = 1) were included as the final dataset for this review. Trials evaluating the effect of d-limonene (n = 2) showed it was well tolerated in subjects. One study (n = 43 participants) showed d-limonene concentrated in breast tissue (mean 41.3 μg/g tissue) and reduction in tumor cyclin D1 expression, which is associated with tumor proliferation arrest. This study did not show meaningful change in serum biomarkers associated with breast cancer, except for a statistically significant increase in insulin-like growth factor-1 (IGF-I) levels. While elevation of IGF-I is associated with increased cancer risk, the clinical implication of this study remains uncertain given its short duration. Trials with perillyl alcohol (n = 3) showed low tolerance and no effect on breast cancer. Conclusion This review demonstrated a dearth of clinical studies exploring the effect of d-limonene and its derivatives on breast cancer. Limited literature suggests d-limonene is safe and tolerable in human subjects compared to its derivative, perillyl alcohol. Our review demonstrates the need for additional well-powered placebo-controlled trials that assess d-limonene’s efficacy on breast cancer compared to other therapies.

Integrative health care (IH) is an approach to health that utilizes biomedical and social determinants of health to promote health and prevent disease, focusing on primary, secondary, and tertiary prevention, and utilizing not only the clinician–patient relationship but also how the family and community contribute to health promotion and disease. IH is a nascent area of practice within public health training. However, many people with a graduate degree in public health have a clinical profession that contributes to integrative primary health. To support the development of a competency-based education for IH, the National Center for Integrative Primary Healthcare convened an interprofessional leadership team to develop 10 “meta-competencies” in integrative primary health care. Following the development of the meta-competencies, individual members of the leadership team worked with colleagues within their profession to develop subcompetencies for specific professions for each meta-competency, including public health. The meta-competencies and public health subcompetencies were used to develop an online 33-hour introductory IH course: “Foundations in Integrative Health.” The public health subcompetencies were used to guide the development of a case study for a 6-hour unit, “Interprofessional Practice in Community Settings and Systems at Large,” on how to conduct and utilize a community health assessment that focused on health equity issues related to diabetes, which can also be taken as a stand-alone course.

Here, we discuss the link between nutrition, non-communicable chronic diseases and socio-economic standing, with a special focus on the microbiota. We provide a theoretical framework and several lines of evidence from both animal and human studies that support the idea that income inequality is an underlying factor for the maladaptive changes seen in the microbiota in certain populations. We propose that this contributes to the health disparities that are seen between lower-income and higher-income populations in high-income countries.

Anthropometric measurements, including height and length, are routinely needed for health research worldwide. Measurement boards are the current gold standard for obtaining the height and length of children. In community-based research, however, the size and weight of the measurement boards make them difficult and cumbersome to carry in the field. In addition, children and infants may express an unwillingness to be placed onto the measurement board. Electronic measuring tools commonly used in industry and contracting work are precise and portable. This study piloted a protocol to use an adapted laser measurement tool, the anthropometric measurement assist (AMA), to obtain height and recumbent length in children in Western Kenya. Intra- and inter-observer variability were determined and compared with measurement board measurements. Results of this initial pilot indicated that the AMA may be a viable alternative to measurement boards. The AMA can measure height/length accurately and reliably, is portable and is equivalent in price to measuring boards, making it a viable option for fieldwork in low-resourced countries.

The Western Region Public Health Training Center (formally the Arizona Public Health Training Center) conducts competency-based needs assessments and provides workforce development assistance to public health agencies in the U.S. Department of Health and Human Services Region IX. Since its launch in 2012, the Center’s Public Health Essentials in Action Training has evolved. It is now offered in-person and online and has been adapted for rural communities. The evolution of the training, beginning with course planning and development, is described, as well as how factors in the public health workforce influenced the course’s evolution and how the course has been adapted for different platforms and populations. Finally, an overview of evaluation efforts offers insight into course effectiveness for this and other trainings offered by the Western Region Public Health Training Center.

Background Public health literature is replete with evidence on individual and interpersonal indicators of modern contraceptive use. There is, however, limited knowledge regarding healthcare system indicators of modern contraceptive use. This study assessed how the healthcare system influences use of modern contraceptive among women in Ghana, Kenya, and two large population states in Nigeria. Methods This study used data from Phase 1 of the Performance Monitoring and Accountability 2020. The analytical sample was limited to women with a need for contraception, defined as women of reproductive age (15 to 49 years) who wish to delay or limit childbirth. Therefore, this analysis consisted of 1066, 1285, and 1955 women from Nigeria, Ghana, and Kenya respectively. Indicators of healthcare assessed include user-fees, visit by health worker, type of health facility, multiple perinatal services, adolescent reproductive healthcare, density of healthcare workers, and regularity of contraceptive services. All analyses were conducted with SAS (9.4), with statistical significance set at p Results The prevalence of modern contraceptive was 22.7, 33.2, and 68.9% in Nigeria, Ghana, and Kenya respectively. The odds of modern contraceptive use were higher among Nigerian women who lived within areas that provide adolescent reproductive healthcare (OR = 2.05; 95% C.I. = 1.05—3.99) and Kenyan women residing in locales with polyclinic or hospitals (OR = 1.91; 1.27—2.88). Also, the odds of contraceptive use were higher among Kenyan women who lived in areas with user-fee for contraceptive services (OR = 1.40; 1.07–1.85), but lower among Ghanaian women residing in such areas (OR = 0.46; 0.23—0.92). Lastly, the odds of modern contraceptive use were higher among women visited by a health-worker visit among women in Ghana (OR = 1.63; 1.11—2.42) and Nigeria (OR = 2.97; 1.56—5.67) than those without a visit. Conclusion This study found an association between country-specific indicators of healthcare and modern contraceptive use. Evidence from this study can inform policy makers, health workers, and healthcare organizations on specific healthcare factors to target in meeting the need for contraception in Ghana, Kenya, and Nigeria.

Objective:To examine the impacts of a Solar Market Garden 1-year solar-powered drip irrigation (SMG) programme in Kalalé district of northern Benin on mothers’ nutritional status and micronutrient levels.Design:Using a quasi-experimental design, sixteen villages were assigned to four groups: (i) SMG women’s groups (WG); (ii) comparison WG; (iii) SMG non-WG (NWG); and (iv) comparison NWG. Difference-in-differences (DID) estimates were used to assess impacts on mothers’ food consumption, diversity, BMI, prevalence of underweight (BMI < 18·5 kg/m2) and anaemia, and deficiencies of iron (ID) and vitamin A (VAD).Setting:Kalalé district, northern Benin.Participants:Non-pregnant mothers aged 15–49 years (n 1737).Results:The SMG programme significantly increased mothers’ intake of vegetables (DID = 25·31 percentage points (pp); P < 0·01), dietary diversity (DID = 0·74; P < 0·01) and marginally increased their intake of flesh foods (DID = 10·14 pp; P < 0·1). Mean BMI was significantly increased among SMG WG compared with the other three groups (DID = 0·44 kg/m2; P < 0·05). The SMG programme also significantly decreased the prevalence of anaemia (DID = 12·86 pp; P < 0·01) but no impacts were found for the prevalence of underweight, ID and VAD.Conclusions:Improving mothers’ dietary intake and anaemia prevalence supports the need to integrate gender-based agriculture to improve nutritional status. However, it may take more than a year, and additional nutrition and health programmes, to impact the prevalence of maternal underweight, ID and VAD.

ObjectiveTo identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children.DesignCross-sectional, comprising a household, health and nutrition survey and determination of Hb, biochemical (serum concentrations of ferritin, retinol, C-reactive protein and α1-acid glycoprotein) and anthropometric parameters. Multivariate logistic regression examined associations of various factors with anaemia and micronutrient deficiencies.SettingKalalé district, northern Benin.SubjectsMother–child pairs (n 767): non-pregnant women of reproductive age (15–49 years) and children 6–59 months old.ResultsIn women, the overall prevalence of anaemia, ID, Fe-deficiency anaemia (IDA) and VAD was 47·7, 18·3, 11·3 and 17·7 %, respectively. A similar pattern for anaemia (82·4 %), ID (23·6 %) and IDA (21·2 %) was observed among children, while VAD was greater at 33·6 %. Greater risk of anaemia, ID and VAD was found for low maternal education, maternal farming activity, maternal health status, low food diversity, lack of fruits and vegetables consumption, low protein foods consumption, high infection, anthropometric deficits, large family size, poor sanitary conditions and low socio-economic status. Strong differences were also observed by ethnicity, women’s group participation and source of information. Finally, age had a significant effect in children, with those aged 6–23 months having the highest risk for anaemia and those aged 12–23 months at risk for ID and IDA.ConclusionsAnaemia, ID and VAD were high among rural women and their children in northern Benin, although ID accounted for a small proportion of anaemia. Multicentre studies in various parts of the country are needed to substantiate the present results, so that appropriate and beneficial strategies for micronutrient supplementation and interventions to improve food diversity and quality can be planned.

Objective Adolescent overweight and obesity and smoking continue to be very important health challenges because of their lasting effects on overall health. Weight gain after smoking cessation is a barrier to quitting as well as a negative consequence to health. This study reports changes in the body mass index (BMI) z-scores of adolescent smokers participating in a dose-ranging clinical trial of bupropion SR (150 mg/day and 300 mg/day) for smoking cessation. Methods A total of N = 296 adolescent smokers (placebo n = 100, 150 mg/day n = 101, 300 mg/day n = 95) with a BMI z-score of 0.5 (sd: 1.4), 0.5 (sd: 1.3), and 0.5 (sd: 1.2) in the placebo, 150 mg/day, and 300 mg/day groups, respectively, were followed for 6 months. Results Adolescents in the 300 mg/day group had a significant reduction in BMI z-score 6 weeks after quitting (β = −0.16, CI = (−0.29, −0.04), P-value = 0.01). This result was not sustained at the 6-month follow-up. Conclusions A reduction in BMI z-score during smoking cessation with bupropion has important implications for the future of adolescent smoking cessation. These results are particularly relevant for adolescents who have either overweight or obesity or who have reservations about quitting for fear of gaining weight or BMI.

In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 "meta-competencies" through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year.2014 年 10 月，国家综合初级卫生 保健中心 (NCIPH) 启动，该中心是 亚利桑那大学结合医学中心以及结 合医学与健康学术联盟的合作产 物，并得到了健康资源和服务管理 局拨款支持。NCIPH 的主要目标是 开发一组跨专业基层医疗培训的核 心综合健康 (IH) 技能和教育方 案，以及实践论坛，并最终成为基 层医疗培训的一个必要部分。本文 报告了 NCIPH 工作的第一个阶段， 此阶段集中开发一组可以共享的综 合医疗护理技能，用于基层医疗学 科。本文描述了 10 种“元胜能 力”的开发、改进和应用流程，此 流程由一个多元化跨专业合作团队 完成。团队成员包括护理、初级医 疗保健专业、药学、公共卫生、针 灸、物理疗法、脊椎按摩疗法、营 养学和行为医学专业人员。本文提 供了所涉及的每个专业学科的专属 子技能示例，并提供了对每个学科 的潜在障碍和应用协调者评估的结 果。本文显示的技能将形成 NCIPH 45 小时网络课程的基础，用于基 层医疗培训计划，2016 年初，此课 程将面向不同领域的受众试开放， 修改后将继续面向更多受众开放。.En octubre de 2014, se inauguró el Centro nacional de atención primaria integral de salud (National Center for Integrative Primary Healthcare, NCIPH) como una colaboración entre el Centro de medicina integral de la Universidad de Arizona y el Consorcio académico de salud y medicina integral, y fue subvencionado con fondos de la Administración de Recursos y Servicios de Salud. El objetivo principal del NCIPH es desarrollar un conjunto básico de competencias de asistencia sanitaria integral (SI) y programas educativos que abarquen los espectros de formación y práctica en atención primaria interprofesional y se integren en última instancia en la educación en atención primaria. Este artículo detalla la primera fase de la iniciativa del NCIPH, que se centra en el desarrollo de un conjunto de competencias compartidas en asistencia sanitaria integral para las disciplinas de atención primaria. Se describe un proceso de desarrollo, perfeccionamiento y adopción de 10 “metacompetencias” a través de un proceso de colaboración en el que participa un equipo interprofesional heterogéneo. Los miembros del equipo representan al personal de enfermería, las profesiones médicas de atención primaria, farmacia, salud pública, acupuntura, naturopatía, quiropráctica, nutrición y medicina de la conducta. Se ofrecen ejemplos de las subcompetencias específicas de cada disciplina en fase de desarrollo en cada una de las profesiones participantes, junto con los resultados iniciales de la evaluación de los posibles obstáculos y los facilitadores de la adopción dentro de cada disciplina. Las competencias que se presentan aquí constituirán la base de un plan de estudios en línea de 45 horas elaborado por el NCIPH para su uso en programas de formación en atención primaria que se pondrán a prueba a principios de 2016 y serán posteriormente revisados para la generalización de su uso el año siguiente.

Background Community Food Bank of Southern Arizona (CFBSA) clients have self-reported a high prevalence of diet-related disease. Understanding the relationship between diet quality and disease can inform interventions designed to improve the health of food bank clients. Objective The aim of this cross-sectional study was to characterize CFBSA clients’ diet quality and its components. Study Design, Settings, Participants CFBSA clients were recruited from three locations June-December 2018. Age, gender, race/ethnicity, employment, diet-related disease risk, and frequency of government and food bank assistance were collected by study staff on site. Respondents were invited to enroll and complete one interviewer-administered 24-hour dietary recall. Measurable Outcome/Analysis The Healthy Eating Index (HEI)-2015 was used to assess diet quality. Intake of 13 (HEI) -2015 components were summarized. Differences in household demographic, socioeconomic, and disease status were compared between participants who did/did not complete the 24-hr recall. Results Two hundred and thirty four participants were enrolled; 197 completed the study (77.4% female; 56.0 ±13.9 years-old; 81.5% non-White; 40.3% indicated ≥12 food bank visits in the past year). Self-reported household health conditions included diabetes (41.7%), high blood pressure (59.7%), and high cholesterol (48.9%). The mean diet quality score for the sample was 52.3 ± 15.6 (range 11.5-86.8). HEI standards were only met for protein, but fell short for total and whole fruit, total vegetables, greens & beans, whole and refined grains, dairy, seafood/plant protein, added sugar, saturated fat, sodium, and mono-/poly-unsaturated to saturated fatty acid ratio. There were no significant differences in demographics, socioeconomic or disease status between those who did/did not complete the recall. Conclusion Diet quality among CFBSA clients was low compared to national multiethnic studies, and reflected low intake of fruit, vegetables, dairy, and seafood/plant proteins, and fatty acid ratio, and high intake of added sugar, saturated fat, sodium, and refined grains relative to recommendations. These data provide specific targets for a future CFBSA-led intervention to reduce diet-sensitive disease burden in clients. Funding Community Food Bank of Southern Arizona.

This chapter presents the indicators that are used to measure the spectrum of malnutrition. It provides information on how to use indicators of food security, dietary intake, anthropometry, and biomarkers to assess the nutritional status at the global, national, household, and individual level. It highlights new areas of research regarding nutritional assessment such as metabolomics and gut microbiota that can help determine differences in nutritional status and dietary patterns. These indicators of nutritional status have significant variation across regions of the world and are used to assess global and national prevalence of different forms of malnutrition as well as to track progress toward improving nutrition. These indicators are also used to assess the impact of nutrition interventions, whether in research studies or for public health programs. When selecting indicators for these purposes it is important to take into account what they indicate, how responsive they are likely to be to the specific intervention(s) and to note that indicators are also affected by a person’s age, sex, and non-nutritional factors.

Known factors associated with under-reporting energy intake (EI) include anthropometry, energy expenditure, psychological factors, smoking, and gender. There is insufficient information on the association between chronic disease status and under-reporting EI. Using NHANES III data from non-pregnant adults aged  20 years, reported EI was esti- mated from a single 24-hour dietary recall and compared with estimated basal metabolic rate (BMRest) among 1503 dia- betics and 17,010 non-diabetics. Multiple linear regression and logistic regression were performed to compare under- reporting between diabetics and non-diabetics, and if it was associated with a hemoglobin A1c within diabetics. Using EI:BMRest < 0.9, male and female diabetics were 2.1 and 3.4 times as likely to under report EI compared to non- diabetics after controlling for weight, age, education, usual intake level, physical activity, tobacco and alcohol use. This greater under-reporting by diabetics could bias the association between diet and disease toward the null in epidemiological studies.

Energy underreporting is a concern with dietary intake data; therefore, subject characteristics associated with underreporting energy intake should be elucidated. Baseline self-reported dietary intake and measures of diet and weight history, life status, weight-loss readiness, psychology, eating behavior, physical activity, and self-image of obese middle-aged women (mean body mass index [calculated as kg/m 2 ]=31.0) enrolled in a lifestyle weight-loss program were evaluated. Of the 155 participating, 71 women were identified as underreporting energy intake using the Goldberg cutoff values. Comparison of means between psychosocial and behavioral measures from energy underreporters and energy accurate reporters were used to help develop logistic regression models that could predict likelihood to underreport energy intake based on baseline measures. Characteristics most predictive of energy underreporting included fewer years of education ( P =0.01), less-realistic weight-loss goals ( P =0.02), higher perceived exercise competence ( P =0.07), more social support to exercise ( P =0.04), more body-shape concern ( P =0.01), and higher perception of physical condition ( P =0.03). These results highlight distinct psychosocial and behavioral characteristics that, at baseline, can help identify the likelihood an overweight middle-aged woman entering a weight-loss intervention will underreport energy intake. These results can help provide a framework for screening study participants for probability of energy underreporting, based on baseline psychosocial and behavioral measures. This knowledge can help researchers target at-risk subjects and, through education and training, improve the accuracy of self-reported energy intake and, ultimately, the accuracy of energy and nutrient intake relationships with health and disease.

Service learning (SL) is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health. We describe the elements and impact of five distinct week-long intensive SL courses focused on the context of urban, rural, border, and indigenous health contexts. Students involved in these SL courses demonstrated a commitment to community-engaged scholarship and practice in both their student and professional lives. SL is directly in line with the core public health value of social justice and serves as a venue to strengthen community–campus partnerships in addressing health disparities through sustained collaboration and action in vulnerable communities.

Despite making significant economic progress, food insecurity and malnutrition present key policy challenges in Benin. We analyzed the determinants of food insecurity in northern Benin, based on pr...

Background: Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. Medical schools that do include nutrition have not evaluated its effect on clinical skills. Objective: The objective was to determine the efficacy of an integrated undergraduate medical curriculum to increase the quantity of nutrition instruction and to advance nutrition clinical skills demonstrated by medical students. Design: A quasiexperimental design was constructed to determine whether an integrated nutrition curriculum increased the performance on nutrition-oriented clinical examinations of medical school classes that received 1, 2, or 3 y of the curriculum. The evaluation of the curriculum focused on 3 areas: 1) hours of nutrition instruction, 2) the application of nutrition within a clinical setting, and 3) perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes by use of analysis of variance. Data from the American Association of Medical Colleges were analyzed to determine the change in the proportion of students who reported that the amount of time devoted to nutrition was adequate. Results: The implementation of the integrated nutrition curriculum resulted in a doubling of the total hours of required instruction in the medical curriculum (35 compared with 75 h). The mean (± 1 SEM) OSCE nutrition score significantly improved after the implementation of the curriculum (41.7 ± 0.9% compared with 50.6 ± 1.1%) and the percentage of students who reported that the amount of nutrition taught during medical school was inadequate decreased (68.4% compared with 11.5%). Conclusion: Medical students improved their clinical nutrition practice skills through participation in an integrated nutrition curriculum.

Background Despite vitamin A supplementation programs, vitamin A deficiency in children remains a public health concern in Honduras. Aim of the study We investigated the effectiveness of short-term dietary supplementation of mothers with red palm oil as a strategy for improving the vitamin A status of the mother-infant dyad. Methods Lactating mothers in Colonia Los Pinos, a barrio of Tegucigalpa, Honduras, consumed a total of 90-mg β-carotene as red palm oil (n = 32) supplements (n = 36) or placebo (n = 18) in six equal doses over 10 days. Carotenoids and retinol in maternal and infant serum, and breastmilk carotenoids and retinol were measured before and after supplementation. Maternal diet was evaluated by 24-hour recall. Results Maternal serum α-carotene and β-carotene concentrations were increased 2 fold by palm oil compared with 1.2 fold by β-carotene supplements. Changes were significantly different in infant serum α-carotene but not β-carotene among the three experimental groups. Increases in breastmilk β-carotene were greater for the palm oil group (2.5 fold) than for the β-carotene supplement group (1.6 fold) and increases in milk α-carotene concentrations (3.2 fold) were slightly greater than those of β-carotene. There were also small but significant changes among groups in breastmilk lutein and lycopene. Breastmilk retinol was not significantly different among the groups over the treatment period. Conclusions Red palm oil in the maternal diet increases provitamin A carotenoids in breastmilk and serum of the mother-infant dyad. The use of dietary red palm oil to improve the vitamin A status of this population should be further investigated.

This study examined nicotine replacement effects and pre-quit smoking characteristics with respect to post-cessation weight gain in a primarily Mexican-American sample of Hispanic smokers. Hispanic smokers (108) were randomly assigned to receive either nicotine transdermal patch or placebo patch for 10 weeks, during which time smoking status and weight change were measured. The overall weight gain experienced by the successful quitters was greater than that experienced by non-quitters. Differences between quitters and non-quitters were significant for both females (2.0 vs. 0.86 kg; p

Peer education in the Arizona 5-a-Day project achieved lasting improvements in fruit and vegetable intake among multicultural employees. Measures monitored implementation of peer education from peer educators’ logs, the program’s reach from employee surveys, and employees’ use in terms of employees’ dietary change. Peer educators logged 9,182 coworker contacts. Contacts averaged 10.9 minutes, according to coworkers. Coworkers read an average of 4.7 booklets and 2.23 newsletters. Many employees talked with peer educators (59%) and read materials (54%) after the program finished. Employee reports of peer educator contact were positively associated with fruit and vegetable intake. Peer education was implemented as intended and reached many coworkers. It continued after program completion, reached into coworkers’ families, and was used by employees to improve intake. This method can be used with employees who rely on informal sources and whose work presents barriers to wellness activities.

Little is known about the effect on reproducibility of including ethnically unique foods in a food frequency questionnaire. The Southwest Food Frequency Questionnaire (SWFFQ) has a food list that includes foods that are unique to Hispanic populations. 75 adults self‐administered SWFFQs twice. Correlation of responses between administrations was calculated for each food item. Several variables were examined as potential predictors of reproducibility. Linear regression models were constructed to relate predictor variables to reproducibility. No significant differences in reproducibility between the gender or ethnic groups or between food types were detected. The regression models constructed included percentage of participants who ate a food and mean frequency with which the food was consumed as significant positive predictors of reproducibility. It was concluded that inclusion of less frequently eaten food items may lead to lower reproducibility. The results also suggested that subject burnout is not an is...

Although addictive behavior is generally associated with drug and alcohol abuse or compulsive sexual activity, chocolate may evoke similar psychopharmacologic and behavioral reactions in susceptible persons. A review of the literature on chocolate cravings indicates that the hedonic appeal of chocolate (fat, sugar, texture, and aroma) is likely to be a predominant factor in such cravings. Other characteristics of chocolate, however, may be equally as important contributors to the phenomena of chocolate cravings. Chocolate may be used by some as a form of self-medication for dietary deficiencies (eg, magnesium) or to balance low levels of neurotransmitters involved in the regulation of mood, food intake, and compulsive behaviors (eg, serotonin and dopamine). Chocolate cravings are often episodic and fluctuate with hormonal changes just before and during the menses, which suggests a hormonal link and confirms the assumed gender-specific nature of chocolate cravings. Chocolate contains several biologically active constituents (methylxanthines, biogenic amines, and cannabinoid-like fatty acids), all of which potentially cause abnormal behaviors and psychological sensations that parallel those of other addictive substances. Most likely, a combination of chocolate's sensory characteristics, nutrient composition, and psychoactive ingredients, compounded with monthly hormonal fluctuations and mood swings among women, will ultimately form the model of chocolate cravings. Dietetics professionals must be aware that chocolate cravings are real. The psychopharmacologic and chemosensory effects of chocolate must be considered when formulating recommendations for overall healthful eating and for treatment of nutritionally related health issues.

Background: The National Cancer Institute recommends that Americans eat at least five daily servings of fruits and vegetables. National strategies to increase consumption may not reach minority and lower socioeconomic populations. In a randomized trial, peer education was tested for effectiveness at increasing fruit and vegetable intake among lower socioeconomic, multicultural labor and trades employees. Methods: Employees (n = 2091) completed a baseline survey and received an 18-month intervention program through standard communication channels (e.g., workplace mail, cafeteria promotions, and speakers). Ninety-three social networks (cliques) of employees were identified, which were pair matched on intake. At an interim survey (during months 8 and 9), 11 cliques no longer existed and 41 matched pairs of cliques containing 905 employees remained, with one clique per pair being randomly assigned to the peer education intervention. Employees who were central in the communication flow of the peer intervention cliques served as peer educators during the last 9 months of the intervention program. Fruit and vegetable intake was measured with 24-hour intake recall and with food-frequency questions in baseline, outcome (i.e., at 18 months), and 6-month follow-up surveys. All P values are two-sided. Results : By use of multiple regression, statistically significant overall effects of the peer education program were seen in the intake recall (increase of 0.77 total daily servings; P

Objective: Assess the association between reporting bias of dietary energy intake and the behavioral and psychological profiles in women. Design: At baseline a series of questionnaires were administered to 37 women, (the Marlowe-Crowne Social Desirability Scale, Weinberger Adjustment Inventory (WAI), the Eating Disorder Inventory (EDI), the Restraint Scale and Sorensen-Stunkard’s silhouettes). Subjects received training on how to record dietary records. Subjects recorded three days of dietary records to measure energy intake (EI) during a study to determine total energy expenditure (TEE) using doubly labeled water. Reporting accuracy (RA=EI/TEE×100) was determined for each subject. Statistical analysis of the data used a mixed effects model accounting for within subject variability to determine if the psychological scores were associated with reporting accuracy. Setting and subject: Women were recruited with local advertisements in Tucson, Arizona. The women had a mean (±1 s.d.) age of 43.6±9.3 yrs, body mass index (BMI) of 28.7±8.5 kg/m2 and total body fat (%TBF) of 31.9±7.3%. Results: Age and %TBF were significantly and inversely associated with RA. Furthermore, Social Desirability was negatively associated with RA. Body dissatisfaction and associating a smaller body size than one’s own as being more healthy were also associated with a lower RA. Conclusions: These results suggest that Social Desirability and self image of body shape are associated with RA. Modifications in subject training may reduce the effect of these factors on RA. Sponsorship: This project was supported by a grant from the National Institute of Diabetes, Digestive and Kidney Diseases.

ObjectiveData on the prevalence of birth defects and neural tube defects (NTD) in Latin America are limited. The present review summarizes NTD prevalence and time trends in Latin American countries and compares pre- and post-fortification periods to assess the impact of folic acid fortification in these countries.DesignWe carried out a literature review of studies and institutional reports published between 1990 and 2010 that contained information on NTD prevalence in Latin America.ResultsNTD prevalence in Latin American countries varied from 0·2 to 9·6 per 1000 live births and was influenced by methods of ascertainment. Time trends from Bogota, Costa Rica, Dominican Republic, Guatemala City, Mexico and Puerto Rico showed average annual declines of 2·5 % to 21·8 %. Pre- and post-fortification comparisons were available for Argentina, Brazil, Chile, Costa Rica, Puerto Rico and Mexico. The aggregate percentage decline in NTD prevalence ranged from 33 % to 59 %.ConclusionsThe present publication is the first to review data on time trends and the impact of folic acid fortification on NTD prevalence in Latin America. Reported NTD prevalence varied markedly by geographic region and in some areas of Latin America was among the lowest in the world, while in other areas it was among the highest. For countries with available information, time trends showed significant declines in NTD prevalence and these declines were greater in countries where folic acid fortification of staples reached the majority of the population at risk, such as Chile and Costa Rica.

Background: In 1992 The University of Arizona, College of Medicine was awarded support from the NIH to develop an integrated, comprehensive nutrition curriculum for pre‐doctorate education. Historically 35 hr of nutrition instruction were provided, including 9 of 40 essential nutrition topics identified by the American Society of Clinical Nutrition. Description: To meet the need for an expanded curriculum, course materials were revised and new materials were developed to provide 36 of the essential topics and 20 new topics in 75 hours of nutrition education. Evaluation: Change in student nutrition knowledge is currently being evaluated. Early analysis supports improvements in scores on a written nutrition examination and the objective structured clinical examination. Comparison scores of the same students over time will be available in late 1997. Conclusion: Effective curricula which provide appropriate quality and quantity of medical nutrition information can be developed within current medical education...

Background: Pneumatic retinopexy is a procedure for reattaching the retina by injecting an expanding gas bubble and using either laser or cryopexy. The procedure is controversial because there may be a lower initial success rate, and intraocular gas may increase the risk of proliferative vitreoretinopathy. Methods: The authors performed a retrospective review of 107 unpublished consecutive cases of pneumatic retinopexy together with a literature review of 25 statistical series with primary attention to failures. Univariate and multivariate analyses were carried out on the data set, and adjusted odds ratios for risk factors associated with failure were calculated using logistic regression. Results: Initially, 74 (69%) of 107 patients had successful results, and with reoperations the success rate increased to 98%. Failure of the procedure to achieve retinal reattachment occurred soon after the initial procedure, with 86% of recorded failures occurring within the first month. The initial cause of failure was new or missed breaks in 14.9%,reopened initial breaks in 11.2%, and breaks never closed in 4.6%. Risk factors that showed a correlation with failure were patients being male (adjusted odds ratio=2.65), eyes with preoperative visual acuity worse than 20J50 (adjusted odds ratio=1.21), eyes with four quadrants of retinal detachment or total detachment (adjusted odds ratio=2.03), aphakic or pseudophakic eye's (adjusted odds ratio=1.91), and eyes with additional pathologic findings (adjusted odds ratio=3.14). Poor visual outcome was associated with initial visual acuity less than 20/50 (adjusted odds ratio=15.7) and eyes with four quadrants of retinal detachment or total detachment (adjusted odds ratio=5.01). Conclusions: Failures of pneumatic retinopexy occur early in the postoperative course. Factors known to be associated with failure of retinal reattachment using scleral buckling also were associated with failure in pneumatic retinopexy. A higher success rate in females was noted, suggesting that educational efforts may need to be greater in males. Poorer visual results occurred in patients with poor initial vision and in eyes with four quadrants of retinal detachment or total detachments

A nutrition surveillance survey was conducted in June 1990 in four poor rural counties of Hubei Province, China, that included 25 villages and 3,564 children, to determine early feeding practices and the nutrition status of preschool children. Data were collected through interviews, anthropometric measurements, analysis of haemoglobin values, and physical examinations. More than 90% of the infants under 6 months of age were being breast-fed, as were approximately 75% of those 12 months old and 26% of those 24 months old. A trend to introducing solid foods into children's diets at younger ages appeared to have occurred between 1984 and 1988; only 15% of the children ate solid food at 6 months of age and 58% at 12 months in 1984, compared with 23% and 78% respectively in 1988. The children's anthropometric measurements were comparable to international standards for the first months of life, and then weight-forage and height-for-age Z scores deviated negatively. Physical examinations suggested that several micronutrient deficiencies might be present The data also indicated that during a time of sweeping economic changes and expanded health care availability, breast-feeding was maintained, food was introduced into the diets of children at younger ages, and acute malnutrition was not common.

Disability is the result of interactions between biological and environmental factors including the physical, economic, and social barriers imposed on an individual by society. In low and middle-income countries, limited attention has been given to the situation of individuals with intellectual disabilities, who remain seriously neglected. Given the lack of resources available to address mental disorders, it is essential to examine the role of socioeconomic and socio-cultural factors in the lives of these individuals. We conducted interviews of key informants and community members in a shantytown community in Lima, Peru, to explore public knowledge, perceptions, and attitudes regarding intellectual disability. Findings indicated that the most important concern for community members was the longstanding issues associated with poverty. There was a profound lack of awareness of intellectual disability among the general population and an absence of social integration for these individuals. However, interviewees also recognized the productive potential of persons with intellectual disabilities provided they received currently inaccessible support services. The results suggest that educational efforts and intervention strategies must be mindful of the challenges of chronic poverty in order to successfully facilitate the social integration of individuals with intellectual disabilities into the community.

One hundred and twenty-three preoperative, intraoperative, and postoperative variables were evaluated to assess their effect on anatomic success of scleral buckling for retinal detachment. The relative importance of each variable was tested in a logistic regression equation. This equation identified ten significant variables for predicting the outcome of retinal detachment surgery. The significant variables were: preoperative proliferative vitreoretinopathy (adjusted odds ratio, AOR, 13.60), previous buckle by G.F. Hilton (AOR = 8.03), total detachment (AOR = 5.72), preoperative vitreous hemorrhage (AOR = 3.08), tension less than 10 mm Hg (AOR = 2.40), hemorrhagic complications (AOR = 2.62), previous buckles by others (AOR = 2.10), injection into the vitreous at surgery with either saline or balanced salt solution (AOR = 2.32) or air/sulfahexafluoride (AOR = 7.06), and preoperative vision less than 0.3 (20/60 or worse) (AOR = 2.14). The number of cryopexy applications was specifically tested in the equation, but while significant in a univariate analysis, it was not found to be significant in the multivariate analysis.

Data were analyzed from a cross-sectional nutrition surveillance survey to determine the association between extended breast-feeding and growth. The sample consisted of 2148 initially breast-fed children between 12 and 47 mo of age. Breast-feeding for24 mo was associated with a greater height-for-age Z score, and breast-feeding for18 mo was associated with greater weight-for-age and weight-for-height Z scores. These results remained significant after the number of food groups being consumed at 12 mo of age, age when the selected food items were first given to a child, the consumption of powered milk, recent infections, age, sex, birth order, birth weight, county of residence, father's occupation, and mother's education were controlled for. These results suggest that extended breast-feeding in this population, in which food was introduced late in infancy, was associated with improved nutritional status as measured by standard anthropometric indicators.A total of 2148 children 12-47 months of age participated in a cross-sectional nutritional surveillance survey in June 1990 in Hubei Province. Socioeconomic and medical information was obtained for each child from a parent. Weight and height information were converted to WA, HA, and WH Z-score values based on the standards of the National Center for Health Statistics/Centers for Disease Control and Prevention/World Health Organization. 62% of the children were breast-fed for 12 mo. Powdered milk had been consumed by 20.6% of the children, and 13.1% of the mothers reported that their child had a recent infection. The group of children breast-fed for the shortest duration had a significantly lower mean HA Z score than the other 3 groups. The mean HA Z scores for the group aged 18-23 mo. were significantly lower than those for the groups aged 12-17 and 24-35 mo. The group of children who were breast-fed for 24 mo. had the greatest adjusted mean HA Z score. The group of children breast-fed for the shortest duration had a significantly lower mean WA Z score than the 2 groups who were breast-fed for the longest duration. Infants with low birth weight had a lower mean WA Z score, and birth weight was significantly associated with greater WA Z scores (P or= 0.001). Children breast-fed for 18 mo. had a greater adjusted mean WA Z score than did children breast-fed for less time (P or= 0.001). The mean WH Z score was significantly greater for the group aged 36-47 mo. compared with the 2 youngest age groups; and the WH Z score for the group aged 24-35 mo. was significantly greater than that for the group aged 12-17 mo. Infants with low birth weight had lower WH Z scores, and there was a significant correlation between birth weight and the current WH Z score (P or= 0.001).

Forty eyes with age-related macular degeneration and a choroidal neovascular membrane involving the entire foveal avascular zone were enrolled in a pilot study to evaluate an unconventional photocoagulation technique that was postulated to stimulate inhibitors of neovascularization. Eighteen (45%) eyes were treated with extrafoveal scatter macular photocoagulation, and 22 (55%) eyes were treated with this type of photocoagulation and focal extrafoveal ablation of the choroidal neovascular membrane. The eyes were followed for at least 1 year and up to 4 years (average, 2.4 years). One to 7 months after treatment, approximately 45% of the membranes treated with each technique did not leak fluorescein during angiography. The absence of leakage was associated with better visual acuity, but this difference was not statistically significant. At the beginning of the study, the visual acuity was 20/200 or better in 32 eyes (80%) and 20/80 or better in 11 (28%). At the conclusion of the study, the visual acuity was 20/200 or better in 21 eyes (53%) and 20/80 or better in 7 (18%). After treatment, 24 eyes (60%) had the same or better (plus or minus two lines) visual acuities. Compared with eyes in natural history studies, those treated with scatter macular photocoagulation had less visual loss from baseline but did not recover acuity of 20/100 or better more frequently. There was no difference in results between these two methods of treatment.

The authors report 2-year follow-up information on 179 of 198 eyes (90%) enrolled in a previously published multicenter, randomized, controlled clinical trial comparing pneumatic retinopexy (PR) with scleral buckling (SB) for the management of selected retinal detachments. Scleral buckling was compared with PR with regard to redetachment after the initial 6-month follow-up period (1% versus 1%), overall attachment (98% versus 99%), subsequent cataract surgery (18% versus 4%; P less than 0.05), preoperative visual acuity (no significant difference), and final visual acuity of 20/50 or better in eyes with macular detachment for a period of 14 days or less (67% versus 89%; P less than or equal to 0.05). Reoperations after a failed PR attempt did not adversely affect visual outcome. After 2 years, PR continues to compare favorably with SB.

Infections with Encephalitozoon (phylum Microspora) protozoa in immunodeficient patients have emerged worldwide. The prevalence of infections due to Encephalitozoon species in nonclinical populations remains unclear. We conducted a cross-sectional survey of two rural highland villages in Mexico by using monoclonal antibody 3B6 to Encephalitozoon in immunofluorescence to assess the prevalence of Encephalitozoon spores in human stools. We found that 20 (7.84%) of the 255 subjects were positive and that 15 (21.4%) of the 70 households had at least one member who was positive. These results suggest that Encephalitozoon species, most likely Encephalitozoon intestinalis, may be commonly present in community settings.

Free holo-retinol binding protein (RBP) [i.e., unbound to transthyretin (TTR)] plays a role in transporting vitamin A across the placenta during pregnancy. In a cross-sectional study of clinically healthy urban women, we assessed the association among clinical and biochemical factors on estimated concentrations of free holo-RBP during the last trimester of pregnancy. Serum samples obtained from a subsample of women (n = 259), who had participated in the Night Vision Threshold Test study in Nepal, were analyzed for determinations of retinol by HPLC, and RBP, TTR, and alpha-1 acid glycoprotein by radial immunodiffusion. Free holo-RBP concentrations were calculated using dissociation constants for free holo- and apo-RBP. Among these women, 30% were vitamin A deficient based on either the RBP:TTR indexor = 0.36 or serum retinol1.05 micromol/L. Using stepwise regression analyses, the RBP:TTR index explained 75% of the variance in free holo-RBP concentrations, whereas retinol explained only 14%. Women were classified as vitamin A sufficient (n = 185) or deficient (n = 74) using the RBP:TTR index and were stratified into 3 gestational groups (I: 24-28 wk, II: 29-33 wk, III:33 wk). Concentrations of free holo-RBP were higher in vitamin A-sufficient women than in vitamin A-deficient women (mean +/- SEM, 48.1 +/- 1.2 vs. 27.6 +/- 0.8 nmol/L; P0.001), and in a 3 x 2 factorial analysis, the interaction between gestational group and vitamin A status was significant. These results demonstrate that the RBP:TTR index is a useful proxy for free holo-RBP concentration and that vitamin A status affects its distribution.

This study was conducted to validate the night vision threshold test (NVTT) as an indicator of night blindness. A total of 1401 pregnant women from the National Maternity Hospital participated in this study. Women were queried about night blindness and took the NVTT using standardized procedures after 10 min of dark adaptation. Sixteen percent failed the NVTT, but only 6.4% reported having night blindness. Blood samples from women who failed the NVTT (cases) and matched controls indicated the serum vitamin A (SVA) concentration was lower (P < 0.05) in cases (1.19 +/- 0.03 micromol/L) than in controls (1.29 +/- 0.03 micromol/L). The SVA concentrations did not differ between women who reported and did not report night blindness. The SVA concentration was correlated (r = 0.22, P < 0.001) with the NVTT scores. Twenty-five percent of women with an SVA < 0.35 micromol/L reported night blindness while 100% failed the NVTT. Nineteen percent of women with an SVA < 0.70 micromol/L reported night blindness while 73% failed the NVTT. A receiver operating characteristics analysis indicated that the NVTT had greater sensitivity (0.73 vs. 0.19) and less specificity (0.51 vs. 0.87) compared with reported night blindness for women with SVA < 0.70 micromol/L and greater sensitivity (100.0 vs. 0.73) and similar specificity (0.51 vs. 0.50) for women with SVA < 0.35 micromol/L. The NVTT identified women with low SVA and self-reported night blindness was misleading. We provide a preliminary algorithm to predict the population of women with low SVA concentrations.

Douglas Taren*, Johanna Dwyer, Laurence Freedman and Noel W Solomons University of Arizona, Mel and Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, 2231 East Speedway Boulevard, Tucson, AZ 85719, USA: Schools of Medicine, Nutrition and the Jean Mayer Human Nutrition Research Center on Aging at Tufts University, and Frances Stern Nutrition Center, Tufts–New England Medical Center Hospital, Boston, MA, USA: Bar Ilan University, Ramat Gan, and Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel: Center for Studies on Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala

Vitamin A deficiency is the leading cause of preventable childhood blindness in developing countries. Each year an estimated 13.5 million children worldwide are unable to adapt to the dark and half a million children progress to complete blindness annually from lack of vitamin A. Most of the currently available methods for assessing vitamin A status are expensive require sophisticated instrumentation and are not efficacious in field conditions. A simple inexpensive method was developed to identify children with defective dark-adaptability thereby providing a reflection of marginal vitamin A stores. The purpose of this preliminary study was to test the field-efficacy of the Night Vision Threshold Tester (NVTT). 39 middle-school children with a mean age of 13.5 +or- 1.37 years were initially tested for their ability to adapt to the dark using the NVTT and were retested 3 weeks after vitamin A supplementation. A modified retinol dose response (MRDR) test was also conducted before and after vitamin A supplementation. Among those who initially failed the NVTT test 93% (14/15) passed the test after supplementation. All of those who initially passed the NVTT test passed it upon subsequent testing. Those who failed the NVTT test had an odds ratio of 2.3 (95% confidence interval 0.51-9.95) for having low vitamin A levels according to the MRDR test but this did not reach statistical significance due to the small sample size. The NVTT is a prime example of "appropriate technology" for developing nations as it has the potential to be used as a survey tool for assessing functional vitamin A status of individuals and communities with vitamin A deficiency. It would then be possible to target vitamin A distribution programs more judiciously resulting in improved allocation of scarce resources. Large-scale double-blind placebo trials are needed to assess further the sensitivity and specificity of the NVTT. (authors)

Studies have both supported and contested the proposition that lowering plasma cholesterol by diet and medications contributes to depression. Evidence suggests that an imbalance in the ratio of the essential fatty acids (EFAs), namely the n-6 and n-3 fatty acids, and/or a deficiency in n-3 fatty acids, may be responsible for the heightened depressive symptoms associated with low plasma cholesterol. These relationships may explain the inconsistent findings in trials of cholesterol-lowering interventions and depression. Dieting behaviors have similarly been associated with alterations in mood state. This review discusses studies of EFAs and depression and explores the involvement of dieting-related psychological factors as potential confounders.

Low income families were interviewed to determine factors related to the number of family food servings per week. A multiple regression model indicated that participation in WIC (supplemental food program for women, infants and children), household size, and number of different income sources were associated with more family food servings per week. Number of food servings per week decreased the last week of the month most often in families with younger members.

We have previously shown that beta-carotene supplementation of the diets of healthy U.S. mothers increases serum and milk beta-carotene concentrations. Building on these results, we investigated the possibility that beta-carotene supplementation could enhance the vitamin A status of mothers and their nursing infants. Three 30-mg doses of beta-carotene were administered on 3 consecutive days to 44 lactating mothers who had vitamin-A-poor diets. Concentrations of maternal serum and milk carotenoids and retinol were evaluated at baseline and after 2 and 3 days of supplementation. Infant serum carotenoids and retinol were measured at baseline and 2 days following maternal supplementation. beta-Carotene supplementation markedly elevated maternal serum and milk beta-carotene concentrations (nine- and sevenfold, respectively) and resulted in smaller, transient increases of alpha-carotene, lycopene, and beta-cryptoxanthin concentrations in maternal serum. Maternal serum and milk retinol were unchanged in response to the treatment. In contrast, maternal beta-carotene supplementation significantly increased infant serum retinol (P

Ideally, everyone should receive a complete nutritional assessment at some time throughout his/her life cycle. However, a comprehensive nutritional assessment may not always be necessary or economically feasible to complete. In this case, nutritional screening can be used to identify individuals for whom a nutritional assessment is necessary.

The Dietary Guidelines for Americans were developed in 1990 by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (USDHHS) to provide Americans with more specific recommendations on how to eat to reduce the risk of certain chronic diseases. These guidelines are appropriate for all ages including the elderly population.