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Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. Methods: Two 24 h dietary records were collected for 558 children, 2–8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children’s Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. Results: AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN. Conclusions: Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence.

OBJECTIVE: To understand the perspectives of food bank clients affected by type 2 diabetes (T2DM). DESIGN: Semi-structured in-depth interviews conducted with food bank clients. SETTING: Arizona regional food bank. PARTICIPANTS: Twenty English- and Spanish-speaking food bank clients with T2DM or living with a person with T2DM, 45–83-years-old, majority female, Hispanic, and food insecure. PHENOMENON OF INTEREST: Food bank utilization and preferences, and how these related to T2DM management. ANALYSIS: A hybrid thematic analysis combining inductive and deductive reasoning. RESULTS: Three organizing themes emerged from the analysis. First, use of food assistance was influenced by food preferences and ability to pair with existing household foods. Second, desired support included fresh fruits and vegetables, meat, oats, oil, and herbs, and recipes, cooking demonstrations, and social support. Third, factors influencing T2DM management were lack of financial resources, low motivation, insufficient nutrition knowledge, low medication adherence, and multiple co-morbidities. Participants also expressed resilience and interest in improving T2DM management. CONCLUSIONS AND IMPLICATIONS: Among a predominantly Hispanic food bank sample, produce and protein-rich foods, nutrition and culinary education, and social support were components of a supportive food bank experience and should be considered when designing food-based interventions for T2DM management for food insecure persons.

The limited resilience of agricultural and food systems has become an agenda in the time of more extreme natural hazards. The impact of such events is extensive, and the level of damage and recovery strongly depends on ecosystem services, including their own resilience capacity. Most of the time, ecosystems themselves can offer mitigation measures based on the benefits people get from nature, including cultivated and wild biomass for nutrition, materials, or energy; pest and disease control; and regulation of baseline flows, among others. The 27th Conference of the Parties to the United Nations Framework Convention on Climate Change, held in Sharm el-Sheikh, Egypt, addressed issues related to crop production, food security, and nutrition. The information garnered from this conference provided impetus for actions that we believe can ensure a future with the resources needed for sustainable development and that support the health and nutrition for all the inhabitants on Earth.

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.

Sexual assault nurse examiners (SANEs) have received specialized education and clinical training in providing forensic care for sexual assault and abuse victims. SANEs provide compassionate and competent care that promotes emotional recovery for their patients; however, caring for this population puts SANEs at risk for secondary traumatic stress, professional burnout, and compassion fatigue. The research regarding SANEs indicates that there may be multiple personal and organizational factors that affect their development of negative outcomes related to professional quality of life.This study explored challenges SANEs experience in their work and what resources are utilized to promote their resiliency and professional quality of life.SANEs were recruited to complete an anonymous online survey through the International Association of Forensic Nurses community; 69 SANEs completed the survey. Eight of the SANEs also participated in follow-up focus groups.The participants reported many gratifying aspects of their work. They also described challenges related to personal, professional, organizational, and community factors. Many of the reported negative effects align with secondary traumatic stress and professional burnout. The SANEs identified multiple ways to support their resiliency in the context of this difficult work.The nature of this work puts SANEs at risk for developing adverse symptoms related to professional quality of life. SANEs need better support and resources to cope with the demands of their work. Findings of this study will be used to design SANE Well, a support application to promote SANE wellness and resiliency.

Irrigation can facilitate the expansion of agricultural production in multiple dimensions – including increasing crop yields, extending the production calendar to previously unmanageable dry periods, and facilitating production of a diverse array of higher-valued crops like fruits and vegetables. For poor smallholder farmers, this productivity boost is assumed to lead an array of benefits, including improved economic conditions and better food and nutrition security, but results from many irrigation studies in developing regions of the world have been underwhelming. Here we explore the simple and intuitive hypothesis that the benefits to farmers and their families of using irrigation depend on how increases in production are utilized, including whether crops are consumed in the home, monetized, or put to other uses. We use data from a solar irrigation project in Benin, West Africa, and show how the same irrigation technology resulted in a range of impacts on hundreds of beneficiaries. This variation is largely explained by how much individual families either consumed or sold products, and how those changes in consumption and sales then translated into a broad range of benefits. These findings have important implications for work at the food-energy-water nexus, including design and evaluation of irrigation-based projects targeted at smallholders. Importantly, they suggest that historical evaluations of irrigation impacts have likely missed important pathways, and have thus under-estimated the total benefits of irrigation to smallholders in contexts like the semi-arid tropics.

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 Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by health professionals. Intervention Foundations in Integrative Health (FIH), a 32-h online competency-based interprofessional course to address this knowledge gap. Methods The course was pilot-tested by an interprofessional sample of providers in various clinical settings as professional and staff development. Outcome Measures Prior to and following the course, participants completed an IH knowledge test, an IH self-efficacy self-assessment, and validated measures of burnout, wellness behaviors, and attitudes toward IH, interprofessional teams, and patient involvement. Evaluation surveys were administered following each unit and the course. Results Thirty-one percent of the participants (n = 214/690) completed the course. Pre/post course improvements were found in IH knowledge, IH self-efficacy, attitudes towards IH and interprofessional teams, and several wellness behaviors. The course was positively evaluated with 81% of the participants indicating interest in applying IH principles in their practice and 92% reported that the course enhanced their clinical experience. Conclusion This study demonstrates the outcomes of a multi-site, online IH curriculum offered to a diverse group of health professionals in various clinical settings. This course may allow clinical settings to offer an interprofessional, IH curriculum even with limited on-site faculty expertise.

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.

Background: Meeting the food needs of Africa's growing population will require innovative and appropriate technologies whose effectiveness needs to be assessed. Objective: To evaluate the impact of Solar Market Gardens (SMGs) on crops production diversity and dietary diversity in the Kalalé district of Northern Benin. Methods: In 2007, SMGs were installed in 2 villages for women's agricultural groups as a strategy for enhancing food and nutrition security. Data were collected through interviews at installation and 1 year later from all women's group households (30–35 women/group) and from a random representative sample of 30 households in each village, for both treatment and matched-pair comparison villages. Results: Comparison of baseline and endline data indicated increases in the variety of fruits and vegetables produced and consumed by SMG women's groups compared to other groups. The proportion of SMG women’s group households engaged in vegetable and fruit production significantly increased by 26% and 55%, respectively ( P < .05). After controlling for baseline values, SMG women's groups were 3 times more likely to increase their fruit and vegetable consumption compared with comparison non-women's groups ( P < .05). In addition, the percentage change in corn, sorghum, beans, oil, rice and fish purchased was significantly greater in the SMG women’s groups compared to other groups. At endline, 57% of the women used their additional income on food, 54% on health care, and 25% on education. Conclusions: Solar Market Gardens have the potential to improve household nutritional status through direct consumption and increased income to make economic decisions.

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.

Breastfeeding has benefits for women and children regardless of their socioeconomic status or country of residence. Although the World Health Organization (WHO) recommends that infants initiate breastfeeding within one hour of birth, are exclusively breastfed for six months and continue to breastfeed with complementary foods until two years of age or beyond, global practices are far from these recommendations. Breastfeeding improves both maternal and child health. It also promotes child cognitive development and helps them prepare for a bright future. Breastfeeding rates can be improved in a very short time through a package of evidence-based policies and programs to support women. Efforts to support breastfeeding for women who choose to do so include local, national and international policies and programs, implemented within healthcare systems, places of work, education and recreation and in communities. Breastfeeding is essential to achieving nine of the 17 Sustainable Development Goals as well as many other international health commitments.

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.