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This note presents the results of interviews with twenty-five participants in a fruit and vegetable walking program in Central Appalachia. Individuals joined and used the program for a number of diverse reasons, most commonly with the hope of improving their health. Participants also valued the abundance of food and social opportunities. Overall, participants enjoyed the program and utilized it in ways that funders and evidence-based medicine (EBM) methodologies of biometric and anthropometric data collection are not equipped to capture. This research illustrates how people within socioeconomically marginalized regions such as Appalachia utilize community-based networks of social and economic relations to exercise agency and maneuver around broader economic and political constraints.

In the United States, 6.5 million children experience food insecurity. The purpose of this project was to evaluate the Building Blocks for Healthy Kids summer nutrition education program for low-in...

Assessing basic needs of students at colleges and universities is gaining traction across the United States. Our research examined the prevalence of food and housing insecurity at a land-grant inst...

Following rising unemployment rates and consequent loss of income due to COVID-19, many people have been seeking meal assistance. This study examines the impact of a community-based free meal distribution program during the pandemic in Kentucky, reviewing characteristics of recipients of the program. Demographics, health behaviors, food insecure classification, and rating of importance of the meal program were collected. Qualitative feedback on the impact of the program was collected via open response. Of the 92 participants using the meal service, the cohort was female, Black, 43 years of age (43.5 ± 15.0 years), with a household income under 30,000 USD before COVID, decreased income since COVID, and were food insecure. Recipients rated the importance of the service as 8.7 ± 1.8 (of 10), and those with children indicated the importance as 4.2 ± 1.1 (of 5). Qualitative data on program importance highlighted four response categories including “changed habits”, “mental wellbeing”, “provided resources”, and “other”. In response to the COVID-19 pandemic, many individuals have struggled. Meal assistance programs are a fundamental asset in the community that have seen marketed demand since COVID-19. Collaboration with, and evaluation of, meal assistance programs can be valuable for continued programmatic funding support.

Community interventions to improve access to food and physical activity resources can reduce obesity rates and improve obesity-related health outcomes. We describe a Kentucky community project that consisted of collaborating with grocery store managers to improve the consumer food environment and partnering with community members to improve walking trails, bicycle racks, and other physical activity resources. We surveyed 2 random samples of community residents in 6 participating rural counties, 741 in 2016 (year 1) and 1,807 in 2017 (year 2). Fruit and vegetable intake significantly increased from year 1 (mean servings fruits, 2.71; vegetables, 2.54) to year 2 (mean servings fruit, 2.94; vegetables, 2.72). Although moderate physical activity did not change from year 1 to year 2, concern among residents about places to be physically active improved (P = .04). Involving community members in promoting obesity prevention programs may improve dietary intake and alleviate community concern about physical activity.

The purpose of this study was to determine if the amount and variety of fruits and vegetables consumed increased among community-dwelling older adults participating in Kentucky's congregate meal site program following a series of five nutrition education lessons. A convenience sample of older adults attending senior centers (n=35), two intervention (n=19) and two control (n=16) centers, participated in this quasi-experimental pilot study. Following the intervention there was a significant increase in actual fruit and vegetable intake in the intervention group (p

Background Farmers' markets (FM) provide an opportunity for consumers to support local producers and promote fruit and vegetable (FV) intake. Plate It Up! Kentucky Proud (PIUKP) develops healthy recipes incorporating locally-produced specialty crops and educational resources that are then delivered by Extension professionals. In collaboration with local producers, Extension professionals often set up at the FM to provide PIUKP resources and recipe samples. As part of the PIUKP project, evaluation data is collected annually at FM throughout the state. Objective To evaluate the relationship between self-reported FV intake and dermal carotenoid scores in adult FM patrons and to assess the impact of PIUKP recipe sampling at the FM on intent to purchase and prepare locally-produced FV. Study Design, Setting, Participants Over a period of 3 summers, adult patrons (n = 751) at diverse FM's throughout the state were invited to sample a seasonally-appropriate PIUKP recipe and complete a short survey with questions about their typical FV intake, sampling experience, and FM purchasing habits. Dermal carotenoid levels were also evaluated in years 2 and 3 (n = 525) through reflection spectroscopy using the Veggie Meter. Measurable Outcome/Analysis Descriptive statistics are provided. Correlation analyses were used to evaluate the relationship between self-reported FV intake and dermal carotenoid scores. Results The study participants reported consuming an average of 2.22 ± 1.18 servings of fruits and 2.91 ± 1.48 servings of vegetables daily. Mean dermal carotenoid scores were 200.3 ± 87.6; a weak (r = 0.32) positive correlation was found between self-reported FV intake and dermal carotenoid scores. On a scale of 1 to 10 with 10 being “Contributes a Lot,” participants indicated both recipe sampling (7.83 ± 2.23) and recipe cards (7.76 ± 2.34) contributed to their making a recipe using FV purchased at the FM. The majority (77.6%) of participants indicated they were very likely to purchase the FV highlighted in the sampled recipe. Conclusions Self-reported FV intake was weakly correlated with dermal carotenoid scores, indicating further research is needed to evaluate the use of reflection spectroscopy as a marker of FV intake. As well, providing samples of healthy recipes and recipe cards incorporating FV being sold at the FM contributed to the likelihood of purchase and later preparation of the recipe.

Background College food insecurity impacts a significant number of students, potentially having a negative effect on academic success, physical and mental health, and/or wellness. For this reason, interventions that address college food insecurity are vital. Objective To evaluate the demographics and food security status of students utilizing the Farm-to-Fork free weekly lunch initiative at a large land-grant institution and to assess the meal planning and dietary habits of these college students. Study Design, Setting, Participants A 3-semester, cross-sectional study collecting online survey responses from a convenience sample of students participating in the Farm-to-Fork free weekly lunch program. Measurable Outcome/Analysis Primary survey data was used in Pearson chi-square tests to analyze the associations between food security status, demographics, behaviors, and program evaluation findings. Results The survey response rate was 31%. Of the 397 students who completed the online survey, 61% reported experiencing some level of food insecurity with only 13% utilizing campus or community resources to access food. Food security status was significantly associated with daily consumption of 5 food groups (P Conclusion The Farm-to-Fork program provides students with a free well-balanced lunch and educational resources to address issues surrounding college food insecurity and to support student success and wellness. However, there is a need to improve students’ eating habits and utilization of resources for food in times of crisis. Funding University of Kentucky Student Opportunity Grant from The Food Connection, University of Kentucky Student Sustainability Council Grant.

The aging process makes older adults vulnerable to the detrimental health effects of environmental contaminants. Our study assessed older adults’ perceptions regarding diet being protective against environmental contaminants, their levels of concern about exposure, and their interest in learning about protective food-related strategies. A needs assessment to collect such information has not been conducted among older adults. Health fair survey results showed that they perceived diet as beneficial against contaminants, were concerned about health implications of exposure, and were interested in learning how to protect health through diet-related strategies. Results suggest that a nutrition-focused curriculum addressing how dietary strategies can help protect against environmental contaminants is needed for Extension professionals.

INTRODUCTION Obesity rates in Appalachia are among the highest in the United States, and knowledge of upstream approaches to decrease prevalence among this vulnerable population is limited. The primary aim of this study was to examine the association between healthy, diet-based, social marketing interventions in grocery stores and frequency of fruit and vegetable intake. METHODS A social marketing campaign was conducted among 17 grocery stores (N = 240 participant surveys) over 4 months in 5 rural Kentucky counties. Interventions included providing food samples, recipe cards, and promotional discounts on fruits and vegetables and moving high-calorie foods to side aisles. RESULTS Most survey participants reported that recipe cards influenced their desire to purchase ingredients as well as fruits and vegetables in general. Results indicated a significant association between the influence of recipe cards and frequency of fruit and vegetable consumption. CONCLUSION Small-scale interventions in grocery stores influenced purchasing choices among Appalachian residents. Working with various store managers and food venues in rural high-obesity communities is a promising way to encourage purchasing of fruits and vegetables.

Objective To develop, implement, and evaluate Farm-to-Fork, a free weekly meal program for college students that integrates social, sustainable, local, and educational elements at the University of Kentucky (UK). Use of Theory or Research Of the 1,854 students surveyed at UK, 43% experience some level of food insecurity while the majority of student focus group participants (n = 33) shared specific challenges related to affording healthful food, including fresh fruits and vegetables (FV). Research suggests a need for more nutrition education for college students, as more than half of students in one large study did not receive nutrition-related information and desired such information from the university. Target Audience Farm-to-Fork targets food insecure college students at UK. Program Description Farm-to-Fork offers a multidimensional, interdisciplinary approach using the socioecological model with policy, system, and environment changes. Within the community-level and individual-level environment, Farm-to-Fork partners with various entities, while addressing student's physical, social, and economic environment, by providing educational resources, healthy lunchtime meals using recovered foods and produce, and a stigma-free social space to approximately 120 students weekly. Evaluation Methods Electronic surveys from students at Farm-to-Fork were recorded weekly for 12 weeks. Results In Fall 2018, Farm-to-Fork served 1,397 meals to 574 individuals and 70 student volunteers dedicated 400 hours. The average cost per meal was only 61 cents as a result of 1,100 pounds of recovered foods with an estimated value of $1,837 utilized for the meals. Of the 153 students completing an online survey about the Farm-to-Fork program, 65% experienced some level of food insecurity and 83% did not consume foods from the five food groups daily. FV were the most common food groups lacking in the diet. Though improvement suggestions were related to the meal quality and quantity, 96% provided positive feedback on the meal quality. Conclusions Findings from the Farm-to-Fork initiative suggest that it is effective, and there is a need for innovative programming that addresses college food insecurity to promote student success and wellness. Funding University of Kentucky Student Opportunity Grant from Food Connection.

Objective Examine food in cable television programming specifically targeting 11- to 14-year-olds (“tweens”). Design Content analysis of food-related scenes (FRS)—in which food was shown, mentioned, and/or consumed—in 880 minutes of programming was conducted. Setting Five days of afternoon/early evening television programs on the Disney Channel. Main Outcome Measures and Analysis Food references were compared with USDA MyPlate and classified according to modified Ratio of Recommended to Restricted Food Components. Results The authors found 331 FRS, averaging 16.6 scenes/h. Preponderance of FRS was physiological needs (40.7%), followed by display (10%), party (8.5%), social event (8%), and retail store (6.6%). Snacks dominated 41% of FRS, and breakfast, lunch, and dinner were much lower in frequency. Half of FRS was visual only, followed by verbal only. Food references were not congruent with MyPlate recommendations; 42% of food items did not fit into MyPlate food groups. Only 24% of food items were fruit or vegetables, which is considerably less than recommended by MyPlate guidelines. Using modified Ratio of Recommended to Restricted Food Components, 66% of food items scored Conclusions and Implications Tween television programming regularly includes non-nutritious food, which likely influences tweens' attitudes and behaviors. Television programming may consider past approaches to tobacco smoking and health messages on television. More attention is warranted regarding television programming by nutrition educators, researchers, health professionals, and industry specialists.

BACKGROUND Inflammation is commonly associated with malnutrition and cardiovascular disease in end-stage renal failure patients. Anti-inflammatory properties of the isoflavones, a micronutrient component of soy, have been reported in several experimental models and disease conditions, but never in renal failure. We hypothesized that dietary soy isoflavones correct laboratory evidence of systemic inflammation in haemodialysis (HD) patients with underlying high blood levels of C-reactive protein (CRP). METHODS End-stage renal disease patients on chronic HD, with elevated CRP (>10.0 mg/l) were enrolled in this pilot study. The subjects were double-blind randomly distributed with 2 : 1 ratio to receive isoflavone-containing soy-based nutritional supplements (soy group) or isoflavone-free milk protein (control group) for 8 weeks. Serum isoflavone, inflammatory markers and nutrition markers were assessed at baseline and at the end of the treatment. RESULTS Thirty-two subjects were enrolled. Fifteen subjects in the soy group and 10 in the control group completed the study; five dropouts were due to acute illness and two due to food intolerance. After intervention, blood isoflavone levels were 5- to 10-fold higher in the soy group than in the control group [e.g. median genistein (25-75th percentile): 337.9 (175.5-1007) nM in the soy group vs 41.4 (22.9-100.4) nM in the control group; P < 0.001]. However, the isoflavone levels ranged widely in the soy group (e.g. genistein: 33-1868 nM) and, depending on the individual compound, four to seven subjects had end-of-treatment levels that were not different from baseline. Variation from baseline of the individual serum isoflavone levels (Delta-isoflavone) and CRP displayed a strong inverse correlation in the soy group (R = -0.599, P < 0.02). In addition, Delta-isoflavone correlated positively with the variation of albumin (R = 0.522, P = 0.05) and insulin-like growth factor-1 (R = 0.518, P < 0.05). Group levels of CRP were not statistically different after intervention although a trend towards lower levels was noted in the soy group [18.2 (12.7-29.1) mg/l at baseline vs 9.7 (5.2-20.7) mg/l at week 8; NS] but not in the control group [20.6 (9.2-38.5) vs 17.6 (9.1-40.7) mg/l]. CONCLUSION These data suggest the possibility of beneficial effects of isoflavone-rich soy foods on the inflammatory and nutritional status of HD patients with underlying systemic inflammation.

OF THESIS COLOR YOUR PLATE: A PILOT NUTRITION EDUCATION INTERVENTION TO INCREASE FRUIT AND VEGETABLE INTAKE AMONG OLDER ADULTS PARTICIPATING IN THE CONGREGATE MEAL SITE PROGRAM IN KENTUCKY SENIOR CENTERS The purpose of this study was to determine if the amount and variety of fruit and vegetable intake increased among community-dwelling older adults participating in Kentucky’s congregate meal site program following a series of educational nutrition lessons. A convenience sample (n=35) of community-dwelling older adults at two intervention (n=19) and two control (n=16) senior centers in central Kentucky participated in this quasi-experimental pre-post pilot study. Following the intervention there was a trend towards increased self-reported intake in the variety of fruit and vegetables among the intervention group (range:0.03+3.31 to 1.32+2.75 servings per week); a significant increase in the number of days participants incorporated at least 4.5 servings of fruits and vegetables per day intake; significant increases in the incorporation of fruits and vegetables in evening meal, and all meals (p

BACKGROUND Diabetic nephropathy is the most frequent cause of end-stage renal disease in the Western world. Dietary intake, including protein amount and type, seems to affect the progression of renal disease. This pilot study tested the hypothesis that substituting soy protein for animal protein in the diets of diabetics would help correct glomerular hyperfiltration. METHODS Twelve young adults (aged 29.9 +/- 2.4 years) with type 1 diabetes mellitus (duration of diabetes 15.1 +/- 2.3 years) and hyperfiltration (glomerular filtration rate, GFR > 120 ml/min/1.73 m2) completed a crossover, dietary intervention trial. After a four-week assessment of baseline characteristics and dietary habits, subjects were assigned to either a control or soy diet for eight weeks after which each subject was crossed over to the alternative diet for another eight-week period. RESULTS Mean GFR was significantly reduced (p < 0.02) after eight weeks on the soy diet (143 +/- 7.4 ml/min/1.73 m2) compared with baseline (159 +/- 7.7 ml/min/ 1.73 m2) and control diets (161 +/- 10.0 ml/min/1.73 m2). Urinary excretion of the soy isoflavones was significantly higher (p < 0.01) at the end of the soy diet (genistein 1,014.6 +/- 274.1 nmol/h, daidzein 2,645.1 +/- 989.6 nmol/h) compared with baseline (genistein 53.7 +/- 31.1 nmol/h, daidzein 151.1 +/- 74.1 nmol/h) and control diets (genistein 41.1 +/- 13.3 nmol/h, daidzein 127.5 +/- 54.0 nmol/h). The soy diet significantly reduced total and LDL cholesterol by 7% and 9%, respectively. CONCLUSIONS Implementation of a soy-based diet appears to reduce the GFR and total and LDL cholesterol of young adults with type 1 diabetes and glomerular hyperfiltration, thus affecting positively their clinical profile.

BACKGROUND Soya foods, a staple in several Asian countries, have received increasing attention because of their nutritional properties and their high isoflavone content. We have shown recently abnormal pharmacokinetics of soya isoflavones following acute oral intake, in soya-naive end-stage renal disease (ESRD) patients. No information is available, however, about blood levels of soya isoflavones in ESRD patients with habitual soya intake. Additionally, no information is available about the conjugation profile of these compounds in ESRD patients. METHODS To assess the relationship between habitual soya intake on blood isoflavone levels in ESRD patients, we recorded dietary soya food intake and analysed circulating levels of soya isoflavones in randomly selected, clinically stable haemodialysis patients from the United States (n = 20), Thailand (n = 17) and Japan (n = 20). Dietary records and three weekly blood samples were collected from each participant. Combined isoflavones and individual genistein, daidzein, glycitein and O-desmethylangolensin (DMA) were analysed in serum by liquid chromatography/mass spectrometry. Lipid phase micronutrients, including tocopherols, carotenoids and retinol were also measured to compare ethnic differences in isoflavones with those of more common lipid soluble antioxidant micronutrients. RESULTS Soya intake was higher in Japanese than in Thai patients and it was negligible in the US patients. Blood levels of genistein were very elevated and significantly higher in the Japanese patients (1128 +/- 205 nM), as compared with the Thai and US patients (258 +/- 64 and 168 +/- 49 nM, respectively; P < 0.001). The other isoflavones followed the same trend. Daidzein was more concentrated than genistein in the dialysis patients. Robust correlation was present between weekly soya intake and blood isoflavone levels (r = 0.56, P < 0.001). Despite very high total isoflavone concentrations, the levels of unconjugated and sulphated isoflavones in the Japanese patients were comparable to those described in healthy subjects. Compared with the striking difference in isoflavones, more easily accessible dietary antioxidants, including tocopherols, carotenoids and retinol, differed only minimally or not at all in the three groups. CONCLUSIONS ESRD patients appear to accumulate isoflavones as a function of dietary soya intake, resulting in blood concentrations that are higher than those reported in subjects with preserved kidney function. Even in the presence of very elevated total isoflavone levels, the concentrations of the unconjugated and sulphated fractions are comparable to those of healthy subjects. A discrepancy is noted between accumulation of soya isoflavones and other more common lipid-soluble antioxidant micronutrients.