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Objective:Passive, wearable sensors can be used to obtain objective information in infant feeding, but their use has not been tested. Our objective was to compare assessment of infant feeding (frequency, duration and cues) by self-report and that of the Automatic Ingestion Monitor-2 (AIM-2).Design:A cross-sectional pilot study was conducted in Ghana. Mothers wore the AIM-2 on eyeglasses for 1 d during waking hours to assess infant feeding using images automatically captured by the device every 15 s. Feasibility was assessed using compliance with wearing the device. Infant feeding practices collected by the AIM-2 images were annotated by a trained evaluator and compared with maternal self-report via interviewer-administered questionnaire.Setting:Rural and urban communities in Ghana.Participants:Participants were thirty eight (eighteen rural and twenty urban) breast-feeding mothers of infants (child age ≤7 months).Results:Twenty-five mothers reported exclusive breast-feeding, which was common among those < 30 years of age (n 15, 60 %) and those residing in urban communities (n 14, 70 %). Compliance with wearing the AIM-2 was high (83 % of wake-time), suggesting low user burden. Maternal report differed from the AIM-2 data, such that mothers reported higher mean breast-feeding frequency (eleven v. eight times, P = 0·041) and duration (18·5 v. 10 min, P = 0·007) during waking hours.Conclusion:The AIM-2 was a feasible tool for the assessment of infant feeding among mothers in Ghana as a passive, objective method and identified overestimation of self-reported breast-feeding frequency and duration. Future studies using the AIM-2 are warranted to determine validity on a larger scale.

Objective To develop and test parent and early adolescent questionnaires to assess food parenting practices that influence early adolescent food consumption during independent eating occasions (iEOs). Methods Cross-sectional online questionnaires were completed by 206 and 62 low-income parent/early adolescent (11–14 years) dyads at Time 1 and 2, respectively, recruited via a Qualtrics (Provo, UT) US national panel database. Principal component analyses, internal consistency, and test–retest reliability checks were performed. Results Six parallel components were identified for parents and early adolescents with acceptable internal consistency and test–retest reliability. Scales included autonomy support, monitoring, availability, indulgence, expectations, and modeling. All except indulgence were positively correlated with importance of helping early adolescents make healthy choices during iEOs. Conclusions and Implications Additional research is needed to test the questionnaires’ validity regarding relationships between parenting practices and early adolescent consumption during iEOs. Findings could inform development of interventions to improve consumption during these occasions.

Introduction: The use of hemoglobin A1c (HbA1c) to screen for diabetes in patients with cardiovascular disease has shown low sensitivity, and the currently recommended cutoff point may leave many patients undiagnosed. The objective of the study was to examine the degree of agreement among current diagnostic methods for diabetes, including HbA1c, fasting plasma glucose (FPG), and two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) among community-dwelling heart failure (HF) patients. Methods: We included 237 HF participants (20+ years) without history of diabetes or diabetes medication use, using data from the 2005-2016 National Health and Nutrition Examination Survey cycles. Diagnostic criteria for diabetes were based on the American Diabetes Association (ADA) guidelines: (1) HbA1c ≥ 6.5%, (2) FPG ≥ 126 mg/dL, and (3) 2hPG after OGTT ≥ 200 mg/dL. The sensitivity, specificity, and Receiver Operating Characteristic (ROC) curve for HbA1c and FPG were examined against the OGTT (FPG ≥ 126 mg/dL and/or 2hPG ≥ 200 mg/dL) as the reference method. Results: Included participants had a mean age of 65±1 (SE) years, 45.5% were female, and 12.5% were non-Hispanic black. Among included participants, 50 patients were newly diagnosed with diabetes based on ADA guidelines. Hemoglobin A1c alone identified only 27.0% of patients, whereas the OGTT identified 90.1% of patients. The area under the ROC curve, assessing HbA1c performance for the diagnosis of diabetes defined by OGTT, was 0.76 (95% CI, 0.67-0.84). Sensitivity and specificity using the HbA1c cutoff at ≥ 6.5% were 19.1% and 97.5%, respectively. The Youden’s J statistic for HbA1c was maximized at 5.8-5.9% (69.9-64.3% sensitivity and 63.9-70.1% specificity). Conclusion: Our data show that identification of diabetes among HF patients was inadequate on the basis of HbA1c screening alone. Our findings suggest diabetes screening on the basis of the OGTT or an HbA1c cutoff point of 5.8-5.9%.

Introduction: Heart failure (HF) patients are at risk of new-onset diabetes. In non-HF populations, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has shown to be associated with the delayed onset of insulin resistance; however, such effect remains unknown in HF patients without history of diabetes. Methods: Using data from 1999-2016 National Health and Nutrition Examination Survey cycles, we included 348 HF participants (20+ years) without history of diabetes or diabetes medication use and with data on at least one 24-hour dietary recall. Participants were classified by DASH dietary index score quartiles: quartile 1 indicated lowest DASH index scores and lowest DASH adherence, whereas quartile 4 indicated highest DASH index scores and highest DASH adherence. The severity of insulin resistance was examined using the Homeostatic Model Assessment of Insulin Resistance and was further classified by tertiles, where the upper tertile showed the most severe insulin resistance. Associations between the severity of insulin resistance and DASH dietary adherence and its linear trends were examined using logistic regression models. Results: Participants had a mean age of 65±1 (SE) years, 44.2% were female, and 10.5% were non-Hispanic black. The age-, gender-, and race/ethnicity-adjusted odds ratio for the most severe insulin resistance group in participants with highest DASH adherence was 0.32 (95% CI, 0.11-0.99), compared to participants with lowest DASH adherence. A significant trend of more severe insulin resistance was observed as participants showed less adherence to the DASH diet (p=0.02). Conclusion: Adherence to a DASH dietary pattern was associated with improved insulin resistance among community-dwelling HF patients in the U.S. Heart healthy dietary patterns may protect HF patients against new-onset diabetes. Future research is needed to test dietary interventions aimed at the prevention of HF complications and comorbidities.

PurposeThe purpose of this study was to elucidate the association between helminth infections, dietary parameters and cognitive performance, as well as the predictors of undernutrition among school-age children (SAC) living in helminth-endemic fishing and farming communities in Ghana.Design/methodology/approachThis was a cross sectional study involving 164 (9 to 12 years old) SAC from fishing (n = 84) and farming (n = 80) communities of the Kwahu Afram Plains South District of the Eastern Region of Ghana, using structured questionnaires and anthropometric and biochemical assessments.FindingsOverall, 51.2% of the children were males, with no significant gender difference between the communities (p = 0.88). Average age of the children was 10.5 ± 1.25 years, with no significant difference between the farming and fishing communities (p = 0.90). About 53.1% of all children were anemic, with no significant differences between farming versus fishing communities (p = 0.87). Helminth-infected children were significantly anemic (p = 0.03). Mean serum zinc level of all children was 13.1 ± 4.57 µmol/L, with zinc deficiency being significantly higher in children in the farming community (p p = 0.001) and girls (p = 0.117). There was no significant difference in the Raven’s Colored Progressive Matrices cognitive test scores between the two communities (p = 0.79). Predictors of anemia were helminthiasis and pica behavior.Originality/valueThese findings are relevant and have the prospect of guiding the development of intervention programs in addressing the persistent problem of nutritional and cognitive deficits among SAC.

Background: Lack of breastfeeding support is a common barrier reported by African American mothers, whose breastfeeding rates remain significantly below the national average. Despite mothers’ reported use of social network sites to access support on topics relating to child rearing, few studies have examined their use to exchange breastfeeding support. Research aims: To describe (1) the experiences of African American mothers who participate in breastfeeding support groups on Facebook and (2) the breastfeeding beliefs, practices, and outcomes for this population of mothers. Methods: This was a prospective, cross-sectional qualitative study with an online focus group design. The study was guided by Black Feminist Thought and an integrated model of behavior prediction. Four online focus groups ( N = 22) were conducted using video conferencing during September 2017 with African American mothers who were participating in breastfeeding support groups on Facebook. Results: Thematic analysis was used to develop four themes and two subthemes, including creating a community for Black mothers, online interactions and levels of engagement, advantages of participating in online support groups, critiques of online support groups, empowerment of self and others, and shifts in breastfeeding perceptions and decisions. Among participants in this study, positive imagery of African American breastfeeding mothers and ongoing support from women with shared experiences improved confidence with public breastfeeding and prolonged goals for breastfeeding duration. Conclusion: Receiving peer support within Facebook communities may positively influence breastfeeding norms and confidence in breastfeeding, help mothers to overcome breastfeeding challenges, and ultimately extend intended breastfeeding duration.

Introduction: Recent scientific statements highlight the importance of understanding the effects of the coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) on disease management decisions and patient outcomes. Various prevalence estimates of the T2DM burden among HF patients have been reported; however, national estimates are not available. The objective of the study was to assess the prevalence and trends of T2DM (total, diagnosed, and undiagnosed) and prediabetes among community-dwelling HF patients using nationally representative data. Methods: We included 473 participants (20+ years) with a diagnosis of HF using data from the 2005-2016 NHANES survey cycles. Diagnosed T2DM was defined by self-report of a previous physician diagnosis. Undiagnosed T2DM was defined by the absence of a physician diagnosis and the presence of ≥ 1 of 3 criteria: 1) Two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) ≥ 200 mg/dL, 2) Hemoglobin A1c (HbA1c) ≥ 6.5%, 3) Fasting plasma glucose (FPG) ≥ 126 mg/dL. Total T2DM was defined as having diagnosed or undiagnosed T2DM. Prediabetes was defined by the absence of T2DM and the presence of ≥ 1 of 3 criteria: 1) 2hPG after OGTT of 140 mg/dL to 199 mg/dL, 2) HbA1c of 5.7% to 6.4%, 3) FPG of 100 mg/dL to 125mg/dL. We stratified estimates by age-standardized socio-demographic characteristics. Trends of the prevalence of T2DM and prediabetes were examined using logistic regressions. Results: The prevalence rates of total, diagnosed, and undiagnosed T2DM and prediabetes among HF patients were 51.4% (95% CI, 46.0%-56.7%), 37.5% (31.7%-43.6%), 13.8% (10.0%-18.2%), and 36.0% (30.2%-42.1%), respectively. The prevalence of T2DM and prediabetes did not significantly change across individual survey cycles. Conclusion: Rates of T2DM and prediabetes among community-dwelling HF patients in the U.S have been persistently high over the past decade. These findings support the need for the prevention and targeted intervention of T2DM in HF patients.

Malnutrition is a major concern in low- and middle-income countries (LMIC), but the full extent of nutritional deficiencies remains unknown largely due to lack of accurate assessment methods. This study seeks to develop and validate an objective, passive method of estimating food and nutrient intake in households in Ghana and Uganda. Household members (including under-5s and adolescents) are assigned a wearable camera device to capture images of their food intake during waking hours. Using custom software, images captured are then used to estimate an individual's food and nutrient (i.e., protein, fat, carbohydrate, energy, and micronutrients) intake. Passive food image capture and assessment provides an objective measure of food and nutrient intake in real time, minimizing some of the limitations associated with self-reported dietary intake methods. Its use in LMIC could potentially increase the understanding of a population's nutritional status, and the contribution of household food intake to the malnutrition burden. This project is registered at clinicaltrials.gov (NCT03723460).

The purpose of this formative, cross-sectional study was to describe independent eating occasions (iEOs) among a convenience sample of low-income early adolescents (10&ndash, 13 years, n = 46) in 10 U.S. states, including environmental context, foods selected and reasons for selection, and parental rules about foods consumed. Participants took pictures of all foods consumed over 24 h and participated in semi-structured interviews to describe the context of each eating occasion using the pictures as a guide. Responses based on a total of 304 eating occasions were coded to classify foods based on United States Department of Agriculture (USDA) MyPlate food groups and to characterize parental rules and reasons for food selection. Average age was 10.9 &plusmn, 1.1 years and 60% were female. Approximately 58% of eating occasions were classified as iEOs with approximately 65% as snacks. Most iEOs took place at home. Foods frequently consumed during iEOs were from the sweets, total fruit, dairy, and whole fruit food categories. Primary parental rules for iEOs focused on avoiding certain foods and not eating too much. Early adolescents selected foods for convenience, taste preferences, and availability. Foods selected during iEOs were based on parent, household and early adolescent factors, which could be addressed to influence overall diet quality.

INTRODUCTION: The prevalence of metabolic syndrome (MetS) is rising globally. Dietetic intervention, as part of a multidisciplinary team approach, is increasingly being recommended for the effective management of patients with MetS. This study was designed to assess the impact of a dietetic intervention on MetS characteristics of patients attending the Diet Therapy Clinic at Tema General Hospital, Ghana. METHODOLOGY: A prospective pre-post single-arm intervention study was conducted among 168 participants who had been diagnosed with MetS and were referred to the Diet Therapy Clinic for dietetic intervention. Data on body mass index (BMI), waist circumference (WC), fasting blood glucose (FBG), high-density lipoprotein (HDL), serum triglyceride (TG), and blood pressure (BP) were collected at baseline and after three months of receiving a dietetic intervention. RESULTS: The MetS measures (BMI, WC, FBG, HDL and TG) of the patients improved at the end of the three months period (32.9 kg/m2 vs 31.7 kg/m2, p = 0.001; 101.2 cm vs 98.9 cm, p = 0.001; 11.0 mmol/L vs 7.7 mmol/L, p = 0.001; 1.1 mmol/L vs 1.2 mmol/L, p = 0.001; 2.0 mmol/L vs 1.9 mmol/L, p = 0.001 respectively). There were improvements in the mean systolic and diastolic BP values recorded after the three months (153 mmHg vs 131 mmHg, p = 0.001 and 98 mmHg vs 85 mmHg, p = 0.001 respectively). CONCLUSION: Dietetic intervention was found to have improved the MetS characteristics of patients.

Background: According to the Centers for Disease Control and Prevention, 39.1% of African American infants are breastfed at 6 months. However, few studies have explored the breastfeeding experiences of African American women who successfully breastfeed to 6 months or longer durations. Research aim: The goal of this qualitative study was to explore the long-term breastfeeding experiences of low-income African American women using the positive deviance approach. Methods: African American women with breastfeeding experience were recruited through Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) breastfeeding peer counselors. Eligibility criteria included being age 18 or older, currently participating in WIC, and having breastfed one child for at least 6 months in the past 2 years. Semistructured, in-depth interviews were conducted with 11 participants. Interviews were audio-recorded and professionally transcribed. Transcripts were then analyzed for emerging themes using thematic analysis in NVivo software. Results: Participants had on average three children each, with an average length of breastfeeding of 10.5 months per child. Four main themes developed: (a) deciding to breastfeed, (b) initiating breastfeeding, (c) breastfeeding long-term, and (d) expanding breastfeeding support. Participants offered culturally tailored suggestions to improve breastfeeding support for other African American women: prenatal discussions of breastfeeding with health care providers, African American lactation support personnel and breastfeeding support groups, and African American breastfeeding promotion in print and digital media. Conclusion: Women who participated in this study breastfed for longer durations than the national average for African Americans. Findings can inform practice and research efforts to improve breastfeeding rates in this population using lessons learned from successful women.

Objectives For breastfeeding mothers, online support groups through Facebook may be a more convenient and preferred source for accessing breastfeeding information and support, but few studies exist that examine the use of Facebook groups specifically for breastfeeding support. This study explores the sources of support among users of Facebook breastfeeding support groups and a possible mechanism by which support received on Facebook may translate to behavioral outcomes among breastfeeding mothers. Methods From July–September 2017 a survey was distributed online to African American mothers ( N = 277) who participate in breastfeeding support groups on Facebook. The survey assessed network support from Facebook and other sources of breastfeeding support, perceived breastfeeding norms, breastfeeding self-efficacy and breastfeeding attitudes. Correlations and linear regression analysis were used to examine the relationship between covariates and outcome variables. Results The average intended breastfeeding duration among participants in this study was 19 months. Participants reported the highest amount of breastfeeding support received from their Facebook support group, in comparison to other sources of support, and Facebook support was significantly correlated with intended breastfeeding duration ( p Conclusions Breastfeeding support received within Facebook groups may compensate for inadequate support received within mothers’ networks. More research is needed to understand the mechanism through which Facebook support may contribute to prolonged breastfeeding durations.

Background: Over the past 2 decades, southern states in the United States have recorded the lowest breastfeeding rates. It is not known whether awareness of breastfeeding laws and provision of resources play any role in their breastfeeding practices. Research aims: The aims were (a) to describe awareness of breastfeeding laws and provisions by students and employees of institutions of higher learning in the state of Georgia, (b) to describe awareness by race and ethnicity, and (c) to determine factors associated with awareness of breastfeeding laws and provisions among students and employees within Georgia institutions of higher learning. Methods: A cross-sectional online survey of students ( n = 1,923) and employees ( n = 1,311) associated with five institutions within the University System of Georgia ( N = 3,271) was completed. Convenience sampling was used. Data were collected through Qualtrics. Chi-square test was used to examine differences between groups, while logistic regression was used to examine associations. Results: Participants included 33.3% undergraduate, 26.2% graduate students, 24.6% staff, 14.2% faculty, and 1.7% administrators. Over two thirds were female and white. Almost one third reported having a child or children. Awareness of breastfeeding laws and provisions was very low among respondents, with 26.6 and 9.6% aware of federal and state provisions, respectively. While less than 10% were familiar with the Baby Friendly Hospital Initiative program, 52.6% reported their institution provides a supportive environment for breastfeeding. Being a student and being a minority were negatively associated with awareness of laws and provisions that support breastfeeding. Conclusion: The need for focused efforts on increasing awareness of legislative and institutional provisions and support for breastfeeding exists.

Objective: The purpose of this study was to examine the association between early infant feeding and childhood adiposity. Method: This was a cross-sectional study of 29 pre-school age (4 to 6 years) children and their mothers. Mothers were interviewed using a structured questionnaire to assess early infant feeding practices, while the children’s body composition was measured using the BOD POD Pediatric Option Body Composition System. Results: The mean age of the children was 4.9 ± 0.8 years, 82.8% Caucasian and 17.2% Black/African American, while 65.5% were female. None of the mothers reported alcohol consumption or smoking during the pregnancy with the child. Of the 29 children in the study, 41.4% were exclusively breastfed for at least 3 months, 48.3% mix-fed and 10.3% exclusively formula-fed. Although we found significant differences in BMI-for-age z-score (p = 0.033) and BMI-percentile-for-age (p = 0.023), there was no significant differences in fat mass and percent fat mass between the groups. Formula-fed children tended to have slightly higher fat-free mass and percent fat-free mass than both mix-fed and exclusively breastfed children although these differences were not statistically significant. Conclusions: Our findings suggest that the direction of the association between early infant feeding and childhood obesity may be dependent on the indicators used to assess obesity.

OBJECTIVES: Traditional dietary assessment methods in low-middle income countries (LMICs) have considerable limitations. the objective of this study was to test the feasibility of using the Automatic Ingestion Monitor (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera, to monitor food acquisition, preparation and consumption of households in a LMIC setting. METHODS: Data from households in Mampong-Akuapem (n = 5), a semi-rural community, and Kweiman (n = 7), a peri-urban community, in the Eastern and Greater Accra Regions of Ghana, respectively, were evaluated. The AIM was used to monitor household activities for one day. Within each household, the primary caregiver (mother) wore the AIM during waking hours on the chosen day as she went about her daily activities, except any activities where she wanted to preserve privacy. Mothers also responded to a socio-demographic questionnaire and evaluated their perceived burden of wearing the AIM. Images captured by the AIM were processed and annotated in custom-designed software. Time spent in major household related activities around food are described. RESULTS: Households had 1.9 ± 0.3 adults and 2.8 ± 1.6 children (mean ± SD). Primary caregivers were 30.5 ± 5.2 years of age, all were married (1 separated), and had a median of 9 years of formal education. Two mothers were breastfeeding at data collection, but only 1 household had an infant

Breastfeeding benefits both infant and mother, including reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce risk of SIDS, the American Academy of Pediatrics recommends infants sleep on their backs on a separate sleep surface. Our objective was to describe trends and factors associated with breastfeeding and infant sleep practices in Georgia. Pregnancy Risk Assessment Monitoring System 2004-2013 data were obtained from the Georgia Department of Public Health. Chi square tests for trends were utilized to determine whether there were significant linear trends in breastfeeding and infant sleep overtime and by survey phase. After exclusions, 4643 cases remained for analysis. From 2004 to 2013, there was a slight (insignificant) decrease in breastfeeding initiation, with the highest proportion in 2010 (79.9%) and the lowest in 2013 (66.9%). Rates of exclusive breastfeeding increased significantly from 2004 (31.3%) to 2013 (81.7%). During that time, the proportion of infants being placed back to sleep slightly decreased (though not significantly), from 59.7 to 48.9%. The proportion of mothers who reported never bed-sharing increased significantly from 26.7 to 45.1% over this period. The decreasing breastfeeding initiation rates in Georgia diverge from national upward trends, however, exclusive breastfeeding rates by survey phase were slightly higher than national trends. Our results suggest the need for targeted education and support for breastfeeding and safe sleep practices. State-level trends data on breastfeeding and infant sleep practices provide valuable information for state-level public health professionals and policy makers, health care providers, and breastfeeding and safe sleep advocates.

Background: African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors’ perceptions of breastfeeding in African American women. Objective: As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs). Methods: Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner’s socioecological model was used to group categories into themes. Results: Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education. Five main themes emerged to describe factors at multiple levels influencing breastfeeding in PCs’ low-income African American clients: individual, microsystem, exosystem, macrosystem, and chronosystem. Novel findings included (1) having breast pumps may give African American women a “sense of security,” (2) cultural pressures to be a “strong black woman” can impede breastfeeding support, and (3) breastfeeding “generational gaps” have resulted from American “slavery” and when formula was “a sign of wealth.” Conclusion: As PCs described, low-income African American women’s breastfeeding decisions are affected by numerous contextual factors. Findings from this study suggest a need to broaden the public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and sociocultural factors underlying breastfeeding practices in African American women.

The objective of the project was to gain a holistic understanding of the current breastfeeding experiences of mothers, while identifying resources and sup- port for breastfeeding in the Athens-Clarke County and surrounding areas. This was an exploratory qualitative study of in-depth interviews with a total of 21 mothers (12 from WIC; 9 from Full Bloom) from Athens-Clarke County and surrounding areas. The inclusion criteria of the participants were mothers of infants who were 12 months old or younger who delivered in Athens. The mothers were individually interviewed. Informants attributed their success, or lack of, to the presence of a breastfeeding role model. Successful mothers shared how important it is to have peers who breastfed and/or are supportive of breastfeeding. While some reported positive support, others reported negative reaction from their work environment. About 75% of the mothers reported negative or no support from their clinician or staff of the hospital. Some informants reported a perceived lack of honesty on the clinician's part about the possible difficulties and possible problems. It is important that clinicians provide honest and consistent breastfeeding information to prepare mothers for potential challenges that may arise during the course of breastfeeding. a 2014 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.

The increasing numbers of lifestyle related chronic diseases in developing countries call for awareness, early detection, and effective management. The objective of this paper is to report the prevalence of undiagnosed hypertension, diabetes, overweight/obesity, and anemia among residents of selected communities in Ghana. The data comes from a community screening conducted in Ghana as part of the University of Georgia Summer Service Learning Program. Descriptive statistics were used to summarize the data while chi-square and independentt-test compared groups. A total of 976 participants (37.9% males and 62.1% females), 18 years and older, were screened. Mean age was46.25±17.14years, BMI was25.44±5.26 kgm−2, and hemoglobin was12.04±2.22 g/dL. 3.1% and 12.6% reported existing diagnosis for diabetes and hypertension, respectively. Almost half (47.8%) were overweight/obese; 27.0% were hypertensive while 34.0% had diabetes. Also, 28.8% males compared to 37.8% females had diabetes (P=0.015), while 28.2% males compared to 26.2% females were hypertensive (P=0.635). There were differences in BMI (P<0.0001), anemia (P=0.007), and undiagnosed diabetes (P<0.0001) and hypertension (P<0.0001) by community (Takoradi versus Cape Coast) where the screening took place. Findings from the screening exercise call for improved public health education with a focus on lifestyle habits and health seeking behaviors among Ghanaians.

OBJECTIVES: The objective of the study was to determine the familiarity of breastfeeding laws and provision of resources among college students in a large public university in southeastern United States. METHODS: This was a cross-sectional online survey of undergraduate and graduate students of the University of Georgia. Data was collected through Qualtrics. RESULTS: 1,117 college students of which over half (53.1%) were undergraduate students participated in the study. 76.1% self-identified as females while 0.6% self-identified as transgender. About two-thirds of the participants were 24 years or younger with significant age difference between undergraduate and graduate students, and majority being Caucasians. Only 16.1% and 4.5% reported to be familiar with federal and state laws and provisions that support maternal leave and successful breastfeeding. Significantly higher percentage of graduate students reported to be familiar with both federal (P

OBJECTIVES: Traditional dietary assessment methods in low-middle income countries (LMICs) have significant limitations. The objective of this study was to test the feasibility of using the Automatic Ingestion Monitor (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera, to monitor food acquisition, preparation and consumption of a household in a LMIC setting. METHODS: This is a case of an 8-member household from Mampong-Akuapem, a semi-rural community in the Eastern Region of Ghana. The household was made up of mother (35 years), father (37 years), and six children (ages 17 years, 13 years [twins], 8 years, 5 years, and 18 months). Mother has no formal education and works as a cook, whereas the father has elementary education and is a farmer/construction worker. All members of the household consume the same prepared meals. The AIM was used to monitor household activities for a day. The primary food preparer (mother) wore the AIM during all waking hours on the chosen day as she went about her daily activities, except any activities where she wanted to preserve privacy. The mother also responded to a socio-demographic questionnaire and evaluated her perceived burden of wearing the AIM. Images captured by the AIM were processed and annotated in custom software. Major household related activities around food are reported. RESULTS: Overall, a total wear time of 776 minutes (12.9 hr; 76.1% of usual wake time) was recorded with images spanning a total of 681 minutes (11.4 hr; 87.8% of total wear time). Cooking and food preparation (four different meals) accounted for 47.9%, shopping 1.5%, breastfeeding and other child feeding 5.1%, and eating 5.4% (communal 4.9% and non-communal 0.5%), and other daily activities 40.1% of usual wake time. Three main meals captured on the AIM were breakfast (rice porridge - boiled watery rice with added sugar, milk and bread), lunch (fufu - pounded boiled cassava and plantain, and chicken soup), and dinner (kelewele - fried spiced yellow plantains). The AIM was generally accepted by the participant and household members although they preferred a smaller size version. CONCLUSIONS: The AIM has the potential of capturing household food related activities and practices that affect dietary intake and nutritional health in LMIC. FUNDING SOURCES: Funded by the Bill & Melinda Gates Foundation.

Objective To measure the energy content of frequently ordered meals from full service and fast food restaurants in five countries and compare values with US data. Design Cross sectional survey. Setting 223 meals from 111 randomly selected full service and fast food restaurants serving popular cuisines in Brazil, China, Finland, Ghana, and India were the primary sampling unit; 10 meals from five worksite canteens were also studied in Finland. The observational unit was frequently ordered meals in selected restaurants. Main outcome measure Meal energy content, measured by bomb calorimetry. Results Compared with the US, weighted mean energy of restaurant meals was lower only in China (719 (95% confidence interval 646 to 799) kcal versus 1088 (1002 to 1181) kcal; P2 =0.62, P Conclusion Very high dietary energy content of both full service and fast food restaurant meals is a widespread phenomenon that is probably supporting global obesity and provides a valid intervention target.

The prevalence of low birth weight (LBW) is a major public health issue in India (30.0%) and is the highest among South-Asian countries. Maternal autonomy or the mother's status in the household indicates her decision-making power with respect to movement, finance, healthcare use, and other household activities. Evidence suggests that autonomy of the mother is significantly associated with the child's nutritional status. Although previous studies in India reported the determinants of LBW, literature on the association between mother's autonomy and birth weight are lacking. This study, therefore, aims to examine the influence of maternal autonomy on birth weight of the newborn.The study, a secondary data analysis, examined data from the 2005-2006 National Health and Family Survey (NFHS 3) of India. A maternal autonomy score was created through proximal component factor analysis and categorized as high, medium, and low autonomy levels. The main outcome variable included birth weight of the index child obtained from health cards and mother's recall. Descriptive and logistic regression analyses were performed.Results from the study indicate that 20.0% of the index children included in the analysis were born at LBW. Low maternal autonomy was an independent predictor of LBW (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.07-1.53, p=0.007) after adjusting for other factors, and medium autonomy level was not significant.These findings clearly indicate the importance of empowering women in India to combat the high incidence of LBW.

An increasing number of publications have evaluated various breastfeeding peer counseling models. This article describes a systematic review of (a) the randomized trials assessing the effectiveness of breastfeeding peer counseling in improving rates of breastfeeding initiation, duration, exclusivity, and maternal and child health outcomes and (b) scientific literature describing the scale-up of breastfeeding peer counseling programs. Twenty-six peer-reviewed publications were included in this review. The overwhelming majority of evidence from randomized controlled trials evaluating breastfeeding peer counseling indicates that peer counselors effectively improve rates of breastfeeding initiation, duration, and exclusivity. Peer counseling interventions were also shown to significantly decrease the incidence of infant diarrhea and significantly increase the duration of lactational amenorrhea. Breastfeeding peer counseling initiatives are effective and can be scaled up in both developed and developing countries as part of well-coordinated national breastfeeding promotion or maternal-child health programs. J Hum Lact. 26(3):314-326.

The problem of overweight/ obesity among children has led some experts to suggest that the current Institute of Medicine recommenda- tion for pregnancy weight gain may play a role in early childhood over- weight. The study examined the pre- dictors of early infancy weight and body composition as a prospec- tive study that followed mothers and their newborns from birth through 12 weeks postpartum. Participants were 40 mother-infant pairs either exclu- sively breastfeeding or mixed feed- ing. The main outcomes were weight changes, weight-for-height z score, height-for-age z score, weight-for-age z score, BMI-for-age z score, and percent body fat measured by the PEA POD body composition system and adjusted for infant feeding practice and ges- tational age. Female infants accu- mulated higher percent body fat than male infants through the 12 weeks of follow-up. Maternal pregnancy weight gain positively correlated with infant length at the different time points and not infant weight. Maternal prepreg- nancy body mass index (P = .030) and pregnancy weight gain (P = .040) significantly correlated with infant birth weight and not weights at 2, 4, 8, and 12 weeks postpartum. Maternal pregnancy weight gain had an inverse association with infant percent body fat after adjusting for other covariates. In conclusion, maternal pregnancy weight gain predicted infant birth weight but not infant adiposity and subsequent weight through the first 12 weeks after delivery. Higher pregnancy weight gain predicts slower early post- natal growth.

Objectives: This study assessed breastfeeding intentions and previous breastfeeding experiences of vegetarians as well as the differences in breastfeeding intentions and previous breastfeeding experiences between the different vegetarian groups in the United States. Methods: This was a cross-sectional online survey of female vegetarians. The survey link was emailed to administrators of vegetarian listservs for their membership to complete. The outcome measures assessed included breastfeeding intentions and actual breastfeeding practices. Descriptive statistics were used to summarize the outcome variables and other variables of interest, and results reported as percentages and mean ± SD. Binary logistic regression was used to identify predictors of breastfeeding intentions and practice. P-value of < 0.05 was used as criterion for statistical significance. Results: Of the 265 vegetarians completing the online survey, 38.5% were vegans, 30.6% lacto-ovo vegetarians, 10.9% pesco-vegetarians, 8.3% flexitarians, 7.2% lacto-vegetarians, and 4.5% ovo-vegetarians. Overall, participants’ breastfeeding intentions, including exclusive breastfeeding, were higher than actual breastfeeding practice, irrespective of vegetarian type. There was no significant difference between breastfeeding intentions and practices by vegetarian type. Conclusion: The majority of vegetarians who participated in this study and the various sub-types intended to breastfeed, and did breastfeed. Future studies of more heterogeneous and larger sample-size are needed to accurately ascertain the breastfeeding practices of the various vegetarian groups.

The purpose of this study was to evaluate the impact of the Health Matters for Families Program, which is a nutrition and health education intervention on the dietary and general lifestyle habits o...

Many children in Ghana do not meet the dietary and physical activity recommendations for their health due to several reasons including limited nutrition education intervention (NEI) programmes. NEI provides children with information on knowledge, attitudes and practices (KAPs) required to ensure proper dietary intake and physical activity. In this intervention study, we recruited eighty (80) overweight and obese students aged 11-15 years from two schools in the Ga-East municipality of Ghana. Anthropometric, biochemical, dietary and physical activity information were collected on the two groups before and after three months of NEI. Between group comparisons (test and control); before and after interventions were performed using student t-tests. It was shown that NEI improved nutrition knowledge (mean change = 5.13, p

The study assessed the breastfeeding (BF) intentions and practices among the different types of vegetarian women in the United States. This was a cross-sectional online survey. The survey was email...

The objective of this study was to assess mothers’ perceptions of the causes of their child’s malnutrition and thus their responsiveness to the child’s condition. This was a qualitative study. In-d...

This study examined the determinants of support strategies and services provided by community-based breastfeeding counselors (CBBCs) and compared differences in extent of support provided by paid and volunteer counselors. Participants (N = 847) in this internet-based survey were mostly White/Caucasian (74.9%), college-educated (59.0%), and paid CBBCs (63.8%). The majority (75.9%) of volunteer CBBCs compared with their paid full-time (52.1%) and paid part-time (47.4%) counterparts had completed college. Being a full-time paid compared with volunteer/unpaid CBBC was associated with face-to-face counseling (OR = 3.69; 95% CI: 1.93, 7.06), use of client-centered counseling skills (OR = 6.23; 95% CI: 3.40, 11.45), making referrals to social service agencies (OR = 13.18; 95% CI: 6.86, 25.32), and helping position baby (OR = 3.77; 95% CI: 1.64, 8.69). Because of the disparities in CBBC usage of breastfeeding support strategies and continuing education between paid and volunteer CBBCs, there is a need to examine differences in training curricula and determine the facilitators and barriers of continuing education.

Background Studies using community-based breastfeeding counselors (CBBCs) have repeatedly shown positive impact on breastfeeding initiation, exclusivity and duration, particularly among low-income mothers. To date, there has not been a comprehensive study to determine the impact of CBBC attributes such as educational background and training, on the type of care that CBBCs provide. Methods This was a cross-sectional study of a convenience sample of CBBCs to ascertain the influence of counselor education and type of training on type of support and proficiency of CBBCs in communities across the United States. Invitations to participate in this online survey of CBBCs were e-mailed to program coordinators of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), La Leche League, and other community-based health organizations, who in turn invited and encouraged their CBBCs to participate. Descriptive analysis was used to describe participants (N = 847), while bivariate analysis using χ2 test was used to examine the differences between CBBC education, training received and breastfeeding support skills used. Multivariate logistic regression was used to assess the independent determinants of specific breastfeeding support skills. Results The major findings from the research indicate that overall, educational attainment of CBBCs is not a significant predictor for the curriculum used in their training and type of support skills used during counseling sessions, but initial training duration was positively associated with the use of many breastfeeding support skills. Another major influence of counselor support to clients is the type of continuing education they receive after their initial training, with higher likelihood of use of desirable support skills associated with counselors continuing their breastfeeding education at conferences or trainings away from their job sites. Conclusions Our results show that different programs use different training curricula to train their CBBCs varying in duration and content. Counselor education is not a significant predictor of the type of training they receive. Continuing breastfeeding education is a significant determinant of type of counseling techniques used with clients. Further research is therefore needed to critically examine the content of the various training curricula of CBBC programs. This may show a need for a standardized training curriculum for all CBBC programs worldwide to make CBBCs more proficient and efficient, ensuring successful and optimum breastfeeding experiences for mothers and their newborns.

The fatty acid composition in maternal diet and in breastmilk during lactation may be a factor in the development of childhood overweight later in life. To investigate the association between trans fatty acid and adiposity, 96 mother-infant pairs (exclusive breastfed; mixed fed; and formula fed) at 3 months postpartum were interviewed; body composition was measured on site using the BOD POD and PEA POD for mothers and infants, respectively.This was a cross-sectional study. Participants were recruited via convenience sampling from Athens-Clarke and surrounding counties of the state of Georgia. Data were analyzed using χ(2), analysis of variance and regression.There were no significant differences in maternal percent body fat by feeding group (32.70, 33.70, and 35.73%, for exclusive, mixed and formula feeding, respectively). Exclusively breastfed infants had higher percent body fat (24.87%) compared with their mixed-fed counterparts (22.15%) but not formula-fed infants (23.93). Mothers who consumed at least 4.5 g of trans fatty acids/day were 5.8 times more likely to have body fat ≥ 30% than those consuming less (odds ratio=5.81; 95% confidence interval (CI), 1.05, 32.32), and their infants were over two times more likely (odds ratio=2.13; 95% CI, 0.75, 6.01) to have body fat ≥ 24%.Trans fatty acid content of the maternal diet may be associated with both maternal and infant body composition in the early postpartum period. More research is warranted regarding maternal dietary and breastmilk fatty acid composition and their effects on maternal and infant body composition and the development of childhood overweight later in life.

An increasing number of publications have evaluated various breastfeeding peer counseling models. This article describes a systematic review of (a) the randomized trials assessing the effectiveness of breastfeeding peer counseling in improving rates of breastfeeding initiation, duration, exclusivity, and maternal and child health outcomes and (b) scientific literature describing the scale-up of breastfeeding peer counseling programs. Twenty-six peer-reviewed publications were included in this review. The overwhelming majority of evidence from randomized controlled trials evaluating breastfeeding peer counseling indicates that peer counselors effectively improve rates of breastfeeding initiation, duration, and exclusivity. Peer counseling interventions were also shown to significantly decrease the incidence of infant diarrhea and significantly increase the duration of lactational amenorrhea. Breastfeeding peer counseling initiatives are effective and can be scaled up in both developed and developing countries as part of well-coordinated national breastfeeding promotion or maternal-child health programs.

The authors analyzed data from a trial assessing the efficacy of breastfeeding peer counseling (PC) for increasing exclusive breastfeeding (EBF) to (1) examine whether different ethnic groups responded differently to the intervention and (2) document the determinants of EBF. At 2 months postpartum, the prevalence of EBF in the intervention group was 11.4% among Puerto Ricans compared to 44.4% among non-Puerto Ricans ( P = .008). Multivariate logistic regression analyses showed that women who had the intention prenatally to engage in EBF were more likely to do so and those whose mothers lived in the United States were less likely to engage in EBF at hospital discharge. At 2 months postpartum, mothers who were breastfed as children were more likely to engage in EBF, whereas non-Puerto Ricans had a significantly greater response to the intervention than Puerto Ricans (odds ratio, 6.40; 95% confidence interval, 1.45-28.33). There is a need for further studies to determine why different ethnic groups respond differently to EBF promotion interventions.

Little is known about breastfeeding rates and factors that affect the likelihood for ever breastfeeding (BF) among Puerto Rican women residing in the continental United States. A cross-sectional study was designed to examine acculturation and food behaviors among low-income Latinos in Hartford, CT. We examined the association of social capital with the likelihood of BF among women 17 to 40 years of age with a child less than 6 years of age. Chi-square analyses were used to examine the bivariate association between BF and independent variables. Multivariate logistic regression was used to estimate the independent association between social capital and BF after controlling for confounders. Backward stepwise multivariate logistic regression results indicate that mothers who exchanged services with friends or relatives were more likely to have breastfed the previous child (OR=2.65; 95% CI=1.16–6.05) and also more likely to have ever breastfed the index child (OR=2.08; 95% CI=1.07–4.05) compared with their counterparts who did not exchange services. Mothers who listened to only Latino music (vs. those listening to non-Latino music) were less likely (OR=0.49; 95% 0=0.25–0.95) to have breastfed the index child. Findings suggest that social capital, as represented by exchange of services with friends or relatives, is associated with a higher likelihood of BF in this Puerto Rican community.

Background: The debate regarding use of WHO body mass index (BMI) cut-offs for the assessment of nutritional status continues in the scientific community. That is, BMI may not be a true reflection of body composition. Researchers have investigated BMI and percent body fat (%BF) as risk factors for some chronic diseases. Objectives: The current study sought to evaluate the use of BMI to assess %BF and their relationship with high blood pressure (HBP) among Ghanaian adults. Methods: A total of 512 men and women were enrolled in a cross-sectional study, conducted in urban (Accra Metropolitan District [AMD; 276]) and peri-urban (Upper Manya Krobo District [UMKD; 236]) Ghana. BMI and %BF were determined and proportions of underweight, normal weight, and overweight/obese participants were compared. Relationship between BMI, %BF and HBP was investigated. Results and discussion: Mean BMI was greater for participants in the AMD than UMKD (25.69±4.85 and 24.51±4.89; p=0.007). %BF was also greater for men (p=0.001) and women (p=0.012) in the AMD than UMKD, respectively. Participants in the AMD (underweight-7%, normal weight-48%, overweight-24%, obese-21%) and UMKD (underweight-14%, normal weight-55%, overweight-17%, obese-15%) had different %BF (p=0.009) but not BMI (p=0.090). A significantly higher number of participants in the AMD had HBP (26%) than UMKD (19%) (p=0.038). Overweight/obese participants had significantly higher blood pressure compared to underweight/normal weight participants, in both AMD (by BMI; p=0.002 and by %BF; p