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Upon resettlement, refugees face many challenges, including limited knowledge of available food and food insecurity, that increase their risks of diet-related diseases. Nutrition education may help them better navigate the challenges of their new food environments and help them live healthier lives. This review assesses the evidence on nutrition education delivery strategies and outcomes among refugees in the United States and other high-income countries using Levac review guidelines. Multiple electronic databases were searched using combinations of the following terms: nutrition, food, cooking, or gardening; education, workshop, curriculum, class, literacy, or program; and refugee. The quality of the peer-reviewed papers was assessed using the Medical Education Research Study Quality Instrument (MERSQI) scoring method. A total of 1930 studies were identified, and 17 met the inclusion criteria. The mean MERSQI score of the peer-reviewed studies was 9.02 (SD, 3.3; range, 1-14). The key nutrition education delivery strategies included conducting a needs assessment and providing client-centered education, a collaborative approach in program design, and hands-on activities such as cooking and store visits. A refugee's literacy level, cultural, and language barriers are common challenges to nutrition education delivery. Because there is limited evidence regarding the efficacy of programs regarding changes in refugees' nutrition knowledge and diet-related behaviors, future research should include rigorously designed studies and the development and implementation of standardized assessment and training tools. The adoption of a context-specific and flexible model is important for effective nutrition education delivery among the refugee population.

Objective To assess how mothers classify foods and how their eating practices interact with these classifications, with special attention to meanings and uses given to ultra-processed foods. Design Qualitative research with in-depth interviews and pile sorts. Setting Urban Brazilian Amazon. Participants A sample of 34 mothers were selected through theoretical sampling. Analysis Content analysis for in-depth interviews and multidimensional scaling and cluster analysis for pile sorts. Phenomenon of Interest Food classification. Results Classifications were based on context (ie, a time or a situation in which the food is eaten) and foods’ healthiness. Five food groupings based on mothers’ classifications were defined: (1) main meal foods, (2) fruits and fruit juices, (3) convenient foods, (4) leisure foods, and (5) canned sardines. Ultra-processed foods were classified differently from non-ultra-processed foods and considered unhealthy, consumed on special occasions or when there was no time or desire to cook. Conclusions and Implications Results highlight the potential of incorporating context-based categories and personal experiences to guide nutrition interventions and the potential of pile sorts to tailor messages to target populations.

BACKGROUND & AIMS Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. METHODS On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. RESULTS The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P

Objective To review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes. Methods Relevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed. Results Of the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P Discussion This review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions. Implications for Research and Practice This review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.

Background American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education. Objective To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum. Methods Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based key informants, including tribal health administrators, nutrition/diabetes educators, Native elders, and tribal leaders. Four focus groups were conducted with AI/AN adults with T2D (n = 29) and 4 focus groups were conducted with their family members (n = 22). Focus groups and community-based key informant interviews were conducted at 4 urban and reservation sites in the USA. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytic process. Results Three key themes emerged. First, a diabetes nutrition education program for AI/ANs should accommodate diversity across AI/AN communities. Second, it is important to build on AI/AN strengths and facilitators to healthy eating (e.g. strong community and family support systems, traditional foods, and food acquisition and preparation practices). Third, it is important to address barriers to healthy eating (e.g. food insecurity, challenges to preparation of home-cooked meals, excessive access to processed and fast food, competing priorities and stressors, loss of access to traditional foods, and traditional food-acquisition practices and preparation) and provide resources and strategies for mitigating these barriers. Conclusions Findings were used to inform the cultural adaptation of a nutrition education program for AI/AN adults with T2D., To understand key stakeholder perspectives regarding facilitators and barriers to healthy eating for American Indians with type 2 diabetes to inform the cultural adaptation of a diabetes nutrition education program.

Objective Examine associations between soldiers’ eating behaviors, compliance with body composition and fitness standards, and physical performance. Design Cross-sectional study. Setting Eight Army installations. Participants US Army Soldiers (n = 1,591; 84% male). Main Outcome Measures Characteristics, eating behaviors, compliance with body composition and physical fitness standards, and fitness level were assessed via questionnaire. Analysis Bivariate and multivariable logistic regression. Results Eating mostly at a dining facility was associated with lower odds of body composition failure (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.26–0.73); whereas, eating at a fast rate (OR, 1.51; 95% CI, 1.05–2.17) or often/always ignoring satiety cues (OR, 2.12; 95% CI, 1.06–4.27) was associated with higher odds of body composition failure. Eating mostly fast-food/convenience meals (OR, 1.75; 95% CI, 1.19–2.59) and eating at a fast rate (OR, 1.42; 95% CI, 1.04–1.93) was associated with higher odds of physical fitness failure. Skipping breakfast was associated with lower odds of high physical performance (OR, 0.41; 95% CI, 0.23–0.74); whereas, nutrition education was associated with higher odds of high physical performance (OR, 1.02; 95% CI, 1.01–1.04). Conclusions and Implications As eating behaviors are modifiable, findings suggest opportunities for improving the specificity of Army health promotion and education programs.

Objective Studies concerning young children's food-related knowledge have dealt mostly with specific types of knowledge or with researchers’ predetermined categories. This approach may neglect certain aspects of children's knowledge and may limit the understanding of its general structure. The present study aimed to examine and analyze a wide scope of young children's constructed food-related knowledge. Methods Qualitative thematic analysis of 40 kindergartners’ free categorizations of food items. Results Children's food-related knowledge was broad and derived from 3 primary sources: personal experience, environmental experience, and perceived messages. Novel aspects of knowledge were found, such as different treatments of food and partial familiarity with nutrients. Conclusions and Implications The findings demonstrated the existence of various types of young children's food-related knowledge. Attention to the broad spectrum of their knowledge and its possible sources may contribute to the design of relevant and effective nutrition education interventions aimed at young children.

To examine the mediating effects of food resource management skills (FRM) on the relationship between participation in a Supplemental Nutrition Assistance Program Education (SNAP-Ed) nutrition education program and diet quality.Secondary analysis of data from a propensity score-matched sample of participants (n = 396) and nonparticipants (n = 111) in a SNAP-Ed nutrition education program.Independent-samples t tests were used to compare entry, exit, and gain scores in FRM and diet quality between participants and nonparticipants. Structural equation modeling was used to examine direct and mediated relationships among participation, FRM, and diet quality.Food resource management was measured as a summated rating scale, and diet quality measured as Healthy Eating Index and program participation.Mediated effect of FRM on the relationship between participation in a SNAP-Ed program and diet quality was statistically significant (P0.01). The effect size for the mediation effect indicated that about 70% of program participation on diet quality was transferred by FRM skills. The hypothesized model had acceptable fit indices as model χParticipation in a SNAP-Ed program enhanced participants' FRM, which in turn enhanced their diet quality.

BACKGROUND: Although it has been recommended that schools be the hub of efforts to improve child nutrition, research describing school nutrition environments in US public schools and their associations with child health is limited. OBJECTIVE: This study aimed to evaluate the applicability of factor analysis methods to characterize school nutrition environments by identifying underlying factors, or dimensions, in the observed data and to examine the relation between school nutrition environment dimensions and child anthropometric and dietary outcomes. METHODS: This study examined a cross-sectional sample of 4635 US children aged 4–15 y from 386 US elementary and middle schools from the Healthy Communities Study (2013–2015). Data collected from schools were used to create 34 variables that assessed the school nutrition environment. To identify dimensions of school nutrition environments, exploratory factor analysis was conducted with orthogonal rotation, and factor scores were derived using methods to account for sporadic missing data. Mixed-effects regression models adjusted for child- and community-level variables and clustered by community and school examined the associations of school nutrition environment dimensions with child anthropometric and dietary outcomes. RESULTS: Six dimensions of school nutrition environments were derived: nutrition education, food options, wellness policies, dining environment, unhealthy food restriction, and nutrition programs. The unhealthy food restriction dimension was negatively associated with added sugar intake (β = –1.13, P

Introduction Few have examined the effects of psychosocial nutrition interventions targeting young adults, a population with low fruit and vegetable (FV) consumption. This study investigated the impact of nutrition interventions with psychosocial content on improving young adult FV intake. Method This registered systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses. Results Searches on CINAHL, Embase, Medline PubMed, Ovid-Medline, PsychInfo, and Web of Science identified 4,113 records. Twenty-four randomized controlled trials were extracted. Eighteen studies found significant between-group differences in fruit and/or vegetable intake. Young adults with low income and racial-ethnic subgroups were underrepresented. A typology emerged as an organizing framework from the psychosocial intervention content. Interventions were anticipatory, socially engaged, a hybrid (anticipatory and socially engaged), or exposure-based. Studies also reported unintended consequences. Discussion Significant between-group differences were mostly reported by anticipatory, socially engaged, or hybrid interventions, aligning with young adult developmental needs through detailed planning, goal-setting tasks, and/or addressing social norms. Interventions with insignificant differences lacked engagement and adequate exposure. Implications for Research and Practice Demographically inclusive studies are imperative in addressing dietary disparities by socioeconomic status. A typology of interventions emphasizing content rather than theories or treatment strategies widens opportunities for interdisciplinary collaboration. More research is needed to mitigate unintended consequences (boomerang effects) in which FV intake decreased postintervention or participants disengaged in activities intended to increase FV intake.

Objective Provide the first baseline census of Supplemental Nutrition Assistance Program Education (SNAP-Ed) state implementing agencies’ (SIAs) intent to use and evaluate 51 indicators described in the SNAP-Ed Evaluation Framework. Methods A cross-sectional study design was used to administer electronic surveys to 124 SIAs who received SNAP-Ed funding in 2017. Descriptive statistics were used to analyze the results. Results Of 51 indicators, SIAs reported their intent to impact an average of 19 indicators and evaluate an average of 12. More SIAs reported the intention to impact indicators at the individual (59%) and environmental levels (48%), compared with the sectors of influence (20%) and population levels (30%) of the framework. In addition, more SIAs intended to impact and evaluate short- or medium-term indicators, compared with long-term indicators. Conclusions and Implications These findings illustrate the progress made toward aggregating metrics to measure the collective impact of SNAP-Ed.

The study aims to analyze the correlation of helminthiasis, iron intake, and hemoglobin levels in pregnant women in the Public Health Center of Kemusu 2 Boyolali, Central Java, Indonesia. A cross-sectional research design was applied to 164 pregnant women who are in the second-third trimester and selected using simple random sampling. The Cyanmethemoglobin tool was utilized to measure the respondents’ hemoglobin levels. The iron intake was obtained using the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Data analysis applied the Pearson's correlation test. This study discovered that 12.2% of subjects are infected by Ascaris lumbricoides; 34.1% and 36.6% of the subjects suffer from iron intake deficiency and anemia. There is a correlation between helminthiasis, iron intake, and hemoglobin levels in pregnant women (p = .005 and p = .007). Nutrition program is still needed to prevent the helminthiasis, reduce the prevalence of anemia in pregnant women, and improve their iron intake through supplementation and nutrition education.

Summary Background Early childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya's network of community health volunteers. Methods We implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6–24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov , NCT03548558 . Findings Between Oct 1 and Nov 12, 2018, 1152 mother–child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5–Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21–0·83]), receptive language (0·42 SD [0·08–0·77]), and socioemotional scores (0·23 SD [0·03–0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05–0·62]) and socioemotional scores (0·22 SD [0·05–0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49–1·11]) and mixed-delivery villages (0·77 SD [0·49–1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes. Interpretation Parenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health

Objective Examine the acceptability of an evidence-based, contextually tailored, virtual avatar coaching approach for nutrition education among adult-child dyads with low income. Design Structured observations and semistructured interviews. Setting Low-income communities in 2 midsized urban areas. Participants Fifteen African American adult and child (aged 5–10 years old) dyads recruited from community agencies. Phenomenon of Interest Structured observation during the use of the virtual avatar coaching program and qualitative feedback on program experience after using the program. Analysis Transcripts were independently coded by 2 trained coders. Content analysis was conducted to determine trends and patterns in responses, and salient quotes were extracted from the manuscripts. Results The program generated dialogue between the children and adults around preferences and dietary habits. Adults and children described the program as being helpful, informative, motivational, and fun. Adults and children liked that the avatar acknowledged them at a personal level, provided accountability, and was tailored to them and their environment. Children wanted the ability to customize the avatar, more gamification, and avatar demonstration of healthy behaviors. Children felt the program would improve their health behaviors and were interested in using it again. Conclusions and Implications This study highlights information that can be used to improve avatar-based programs for nutrition education with children and their adult caregivers who have low income. Future work should assess the impact of user customization experience, program impact on dietary behaviors, and resources required to scale and maintain the program with community agencies.

Objective To assess the impact of incorporating nudge strategies in the design of a nutrition education workshop invitation on workshop registration among early childhood education and care centers. Methods A parallel-group randomized controlled trial was conducted with 88 centers. Centers received nudge strategies embedded within an enhanced invitation (intervention) or a generic invitation (control) to attend a nutrition education workshop. Center workshop registration and invitation recall and acceptability were compared between the 2 arms. Results No statistically significant differences in workshop registration (25% vs 20%; P = 0.61), invitation recall (69% vs 62%; P = 0.58) or acceptability (mean: 8.38 vs 8.06; P = 0.50) were found between intervention and control centers, respectively. Conclusions and Implications Low-intensity behavioral strategies embedded in the design of an invitation were insufficient to increase workshop registration significantly. Investigation and application of alternate evidence-based nudge strategies to encourage staff participation in nutrition education in early childhood education and care setting are recommended.

Objective To explore intergenerational differences on key factors of food parenting practices (FPPs) related to home eating behavior of schoolchildren. Design In-depth interviews with social recognition theory-based semistructured interviews conducted from December 2016 to January 2017. Participants Primary caregivers of elementary schoolchildren from 23 households (16 parents, 14 grandparents) in 4 remote areas of Hualien, Taiwan. Phenomenon of Interest Factors related to FPPs hindering micronutrient-dense food group consumption by schoolchildren in a remote area. Setting In-depth interviews were conducted at participants’ houses. Analysis Interviews were audiorecorded and transcribed verbatim. Inductive thematic analysis was performed to elicit studied phenomenon. Results Routine family meals provided adequate staple, protein, and vegetables but inadequate whole grains, dairy, fruits, and nuts. More parents provided breakfast composed of pan-fried and semiprocessed products made of refined flour and sugary beverages. Both parents and grandparents had ambiguous nutrition concepts and inconsistent FPPs but in different aspects. They both reflected expectations for assistance from local schools for nutrition and FPPs education to shape up healthy eating behavior of children. Conclusions and Implications Study findings pinpoint the strength and barriers of FPPs for primary caregivers. Implementing integrated nutrition education programs tailored for empowering nutrition literacy and FPPs is suggested to enhance the healthy eating behavior of schoolchildren in a remote area.

To determine the validity and reliability of a nutrition knowledge questionnaire for adolescents.An adult questionnaire was administered to 4 high school student convenience samples with and without known prior nutrition education. Questionnaire refinement was determined by item-total correlation, item discrimination, and item difficulty. Mean percentage of correct answers was calculated, and the group difference was assessed using an independent samples t test. A post hoc regression analyzed the association between mean percentage of correct answers and group while controlling for school.The questionnaire, with 1 question eliminated, had good internal consistency reliability (Cronbach α = 0.83). The nutrition education group (n = 174) demonstrated significantly (P0.0001) higher mean percentage of correct answers compared with the no nutrition education group (n = 136). The association between mean percentage of correct answers and the group remained with school controlled.Results suggest that the questionnaire is valid and reliable for measuring nutrition knowledge in high school-aged adolescents.

The role of agriculture in reducing undernutrition is widely recognized, yet there is also consensus on the need to make the sector nutrition-sensitive. Evidence on the impact pathways from nutrition-sensitive agriculture (NSA) interventions, agricultural interventions with specific nutrition objectives, and actions detailing each temporal stage to reach nutrition outcomes is limited, however. We thus synthesized study results regarding impact of NSA interventions on nutrition outcomes relating to undernutrition, and constructed an impact pathway by mapping the evidence on each temporal stage from interventions to nutrition outcomes. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses to conduct and report our systematic review of studies on NSA interventions implemented in low- and lower-middle-income countries. Forty-three studies that met the inclusion criteria were extracted and synthesized across impact and pathways analyses. We carried out a thematic analysis of the effect of NSA interventions using evidence-based indicators and constructed the pathways by adopting a published framework on agriculture to nutrition pathways. Our findings reveal that NSA interventions can significantly improve dietary practices, and have the potential to enhance care practices and reduce occurrence of diseases, indicating their effectiveness in simultaneously addressing multiple determinants of undernutrition. However, NSA interventions have a lesser impact on nutritional status. NSA interventions lead to nutrition outcomes through 5 key pathways: food production, nutrition-related knowledge, agricultural income, women's empowerment, and strengthening of local institutions. We emphasize the need to carefully design, implement, and evaluate interventions with consideration for factors affecting impact pathways. Future research should focus on the effect of interventions combining multisector components, and pathways through non-food-production-related income, women's empowerment, strengthening of local institutions, food prices at intervention level, and expenditure on health care., This review synthesizes the impact of NSA interventions on nutrition outcomes and constructs pathways by mapping the evidence on each temporal stage, from the interventions to the nutrition outcomes.

The 1500mg/day dietary sodium-restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in seven trials; none achieved 1500 mg/day (range=1938–4564mg/day). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (e.g., social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.

Iron and zinc deficiencies are some of the most widespread micronutrient deficiencies in low- and middle-income countries (LMIC). Dietary diversification, food fortification, nutrition education, and supplementation can be used to control micronutrient deficiencies. Legumes are important staple foods in most households in LMIC. Legumes are highly nutritious (good sources of essential minerals, fiber, and low glycemic index) and offer potential benefits in addressing nutrition insecurity in LMIC. Several efforts have been made to increase micronutrient intake by use of improved legumes. Improved legumes have a higher nutrient bioavailability, lower phytate, or reduced hard-to-cook (HTC) defect. We hypothesize that consumption of improved legumes leads to optimization of zinc and iron status and associated health outcomes. Therefore, the objective of this review is to examine the evidence on the efficacy of interventions using improved legumes. Nine relevant studies are included in the review. Consumption of improved legumes resulted in a ≥1.5-fold increase in iron intake. Several studies noted modest improvements in biomarkers of iron status [hemoglobin (Hb), serum ferritin (SF), and transferrin receptor] associated with consumption of improved legumes. Currently, no efficacy studies assessing the relation between consumption of improved legumes and zinc status are available in the literature. Evidence shows that, in addition to repletion of biomarkers of iron status, consumption of improved legumes is associated with both clinical and functional outcomes. The prevalence of iron deficiency (ID) decreases with consumption of improved legumes, with increases of ≤3.0 g/L in Hb concentrations. Improvement in cognition and brain function in women has been reported as well. However, further research is necessary in more at-risk groups and also to show if the reported improvements in status markers translate to improved health outcomes. Evidence from the included studies shows potential from consumption of improved legumes suggesting them to be a sustainable solution to improve iron status. ispartof: ADVANCES IN NUTRITION vol:11 issue:5 pages:1315-1324 ispartof: location:United States status: published

Purpose Increasing Culinary Health Opportunities for Professionals (iCHOP) aimed to educate future and current health professionals on nutrition as medicine. Methods Two cohorts each participated in a 16-week course followed by a cultural immersion in Tuscany, Italy. The course took place online through West Virginia University. After the course, participants traveled to Tuscany, Italy for a 2-week cultural immersion. The online course covered culinary medicine, the Mediterranean Diet, and cultural comparisons. The cultural immersion consisted of hands-on activities including culinary lessons, food production and organic farm tours, and tastings of Mediterranean foods. Data was collected through personal journaling in order to capture participants’ thoughts and experiences during the immersion. Journal entries were analyzed using NVIVO Software Version 12 in order to generate themes. Results Cohort 1 (n = 15) consisted of currently practicing health professionals and Cohort 2 (n = 14) consisted of aspiring health professionals. 20 themes and 5 subthemes were generated from 9 journal topics. Themes showed that participants had an increase and knowledge and self-efficacy and applied new information to personal and professional settings. Conclusions Cultural immersions can be an effective way to educate health professionals on nutrition as medicine and using journaling as a data collection method can effectively capture participants’ experiences.

OBJECTIVE: To determine if children’s “pester power” related to a classroom-based nutrition program, Together, We Inspire Smart Eating (WISE), is related to familial dietary habits and parental food purchases and practices. METHODS: Classroom teachers delivered weekly WISE lessons at seven Head Start sites across two states in the Southern United States. Pre- and post-intervention, parents were interviewed on consumption of WISE fruits and vegetables, intake of nutrient-poor foods, parenting practices related to food, and exposure to WISE through the child’s “pester power”. RESULTS: After controlling for baseline levels of outcome variables, child willingness to try new foods at baseline, and the effect of state, “pester power” predicated significant variance in the outcomes of consumption of WISE foods [F(3, 229) = 34.7, p

Background Bariatric surgery is the most effective therapy for severe obesity. It reduces gastric capacity and may modify regulation of appetite, satiety, insulin, and other physiologic processes, resulting in weight loss. Objective Long-term data on postsurgical nutrient intake are lacking. Setting The Longitudinal Assessment of Bariatric Surgery-3 psychosocial study. Methods Reported dietary intake was assessed in a subset of participants (n = 72) of the Longitudinal Assessment of Bariatric Surgery-3 psychosocial study who underwent Roux-en-Y gastric bypass surgery. Two 24-hour diet recalls at presurgery and annual assessments over 7 years were obtained. Reported diets were evaluated for energy, macro- and micronutrient intake, and assessed for adequacy by comparison to the dietary reference intakes. Results After surgery, reported intake of total energy, and all macronutrients were significantly reduced. At least a quarter of participants reported protein intake below the recommended dietary allowance. Over half of participants reported intake of several vitamins (C, D, A, E, thiamin, folate) and minerals (zinc, calcium) below recommended levels over 7 years. Compared with presurgery, reported energy intake was reduced over 7 years. This study was registered at ClinicalTrials.gov as NCT02495142 . Conclusions The reduction in energy resulted in intakes below the dietary reference intakes for many micronutrients among the majority of participants and below the recommended dietary allowance for protein in a substantial subgroup. These data support continued long-term nutrition education, monitoring, and supplementation.

Objective High calorie foods and beverages, which often contain caffeine, contribute to child overweight/obesity. We evaluated the results of an educational intervention to promote healthy growth in very young children. Secondarily, we used detailed diet data to explore the association of nutrient intake with the early development of overweight and obesity. Methods Mothers were obese Latina women, enrolled prenatally, and their infants. Specially trained community health workers provided breastfeeding support and nutrition education during 10 home visits, birth to 24 months. At follow-up, age 18 to 36 months, we measured growth and completed detailed diet recalls (1–7 recall days/child). Results Of 174 infants randomized, 106 children were followed for 24 to 36 months. The educational intervention did not prevent overweight/obesity. Forty-two percent of children became overweight or obese. Fifty-eight percent of children consumed caffeine on at least 1 recall day. Mean intake was 0.48 mg/kg/day. Caffeine correlated with higher consumption of calories, and added sugar and decreased intake of protein, fiber and dairy. Compared with days without caffeine, on days when caffeine was consumed, children ingested 121 more calories and 3.8 gm less protein. Children frequently consumed less than the recommended daily intake of key nutrients such as fiber, vegetables, whole fruit, and vitamins. Conclusions Caffeine was a marker for increased intake of calories and decreased intake of key nutrients. When discussing dietary intake in early childhood, practitioners should screen for nutrient deficiency in young children and recommend limiting the intake of caffeinated foods and beverages.

Objectives Malnutrition is one of the leading causes of death among children younger than five years. In this study, we aimed to formulate a ready-to-use supplementary food (RUSF), based on local food products, and investigate its efficacy on growth indicators in children with mild to moderate malnutrition. Study design This is a randomized controlled clinical trial. Methods This study was performed in six health centers in Shahr-e-Rey, Tehran, Iran, between April and October 2017. One hundred children, aged 24–59 months, with mild to moderate malnutrition (weight-for-height Z-score [WHZ] between −3 and −1) were randomly assigned to two groups to receive either 1–3 sachets of RUSF or normal diet for 8 weeks. All mothers and caregivers received nutrition education. Growth indicators including weight and height, WHZ, and body mass index (BMI), along with clinical outcomes, were assessed. Results Children who received RUSF had a significant increase in weight (1.44 ± 0.38 vs 0.7 ± 0.32 kg, respectively, P −1 at the end of the study (P Conclusions A newly developed RUSF improved growth indicators and clinical outcomes in children with mild to moderate malnutrition. Clinical Trial Registry number IRCT2017021315536N6 (registered at www.irct.ir )

There is a documented substantial gap between the level of nutrition education for medical trainees and the need to provide nutrition counseling. Culinary medicine offers a solution, but there are multiple barriers and no guides to implementation. This article identifies core components and strategies to overcome barriers on the basis of experiences of multiple institutions. The outline forms a foundation to be built upon by future collaborators to empower more widespread implementation of culinary medicine education and improve medical nutrition education and ultimately, patient outcomes.

Background Rural Americans have higher prevalence of obesity and type 2 diabetes (T2D) than urban populations and more limited access to behavioral programs to promote healthy lifestyle habits. Descriptive evidence from the Rural Lifestyle Intervention Treatment Effectiveness trial delivered through local cooperative extension service offices in rural areas previously identified that behavioral modification with both nutrition education and coaching resulted in a lower program delivery cost per kilogram of weight loss maintained at 2-years compared with an education-only comparator intervention. Objective This analysis extended earlier Rural Lifestyle Intervention Treatment Effectiveness trial research regarding weight loss outcomes to assess whether nutrition education with behavioral coaching delivered through cooperative extension service offices is cost-effective relative to nutrition education only in reducing T2D cases in rural areas. Design A cost-utility analysis was conducted. Participants/setting Trial participants (n=317) from June 2008 through June 2014 were adults residing in rural Florida counties with a baseline body mass index between 30 and 45, but otherwise identified as healthy. Intervention Trial participants were randomly assigned to low, moderate, or high doses of behavioral coaching with nutrition education (ie, 16, 32, or 48 sessions over 24 months) or a comparator intervention that included 16 sessions of nutrition education without coaching. Participant glycated hemoglobin level was measured at baseline and the end of the trial to assess T2D status. Main outcome measures T2D categories by treatment arm were used to estimate participants’ expected annual health care expenditures and expected health-related utility measured as quality adjusted life years (ie, QALYs) over a 5-year time horizon. Discounted incremental costs and QALYs were used to calculate incremental cost-effectiveness ratios for each behavioral coaching intervention dose relative to the education-only comparator. Statistical analyses performed Using a third-party payer perspective, Markov transition matrices were used to model participant transitions between T2D states. Replications of the individual participant behavior were conducted using Monte Carlo simulation. Results All three doses of the behavioral coaching intervention had lower expected total costs and higher estimated QALYs than the education-only comparator. The moderate dose behavioral coaching intervention was associated with higher estimated QALYs but was costlier than the low dose; the moderate dose was favored over the low dose with willingness to pay thresholds over $107,895/QALY. The low dose behavioral coaching intervention was otherwise favored. Conclusions Because most rural Americans live in counties with cooperative extension service offices, nutrition education with behavioral coaching programs similar to those delivered through this trial may be effective and efficient in preventing or delaying T2D-associated consequences of obesity for rural adults.

Objective To examine factors associated with Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation through 2 years of age. Design Longitudinal data from the WIC Infant and Toddler Feeding Practices Study-2. Setting Eighty WIC sites. Participants The WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 2 years of age (n = 1,250). Main Outcome Measure WIC participation through 2 years of age. Analysis Multivariate logistic regression and odds ratios. Results Infants in households with incomes ≤100% of the federal poverty level (FPL) were more than twice as likely as those with incomes above 100% FPL to continue WIC participation through 2 years (odds ratio = 2.22; 95% confidence interval [CI], 1.34–3.66). The odds of WIC participation through 2 years were 2.84 times higher for infants fully breastfed for 6 months or longer compared with infants breastfed for less than 6 months (95% CI, 1.43–5.66). Infants in households in which caregivers reported they made a change in how they fed their family on the basis of something they learned from WIC had 2.60 higher odds of continued WIC participation than infants in households in which caregivers did not report making a change (95% CI, 1.67–4.07). Conclusions and Implications In addition to lower household income, longer breastfeeding duration and application of WIC nutrition education are important predictors of WIC participation through 2 years of age.

BACKGROUND: Food preparation interventions are an increasingly popular target for hands-on nutrition education for adults, children and families, but assessment tools are lacking. Objective data on home cooking practices, and how they are interpreted through different data collection methods are needed. OBJECTIVE: The goal of this study was to explore the utility of the Healthy Cooking Index in coding multiple types of home food preparation data and elucidating healthy cooking behavior patterns. DESIGN: Parent-child dyads were recruited between October 2017 and June 2018 in Houston and Austin, Texas for this observational study. Food preparation events were observed and video recorded. Participants also wore a body camera (eButton) and completed a questionnaire during the same event. PARTICIPANTS/SETTING: Parents with a school-aged child were recruited as dyads (n=40). Data collection procedures took place in participant homes during evening meal preparation events. MAIN OUTCOME MEASURES: Food preparation data were collected from parents through direct observation during preparation as well as, eButton, and paper questionnaires completed immediately after the event. STATISTICAL ANALYSES PERFORMED: All data sets were analyzed using the Healthy Cooking Index coding system, and compared for concordance. A paired sample t-test was used to examine significant differences between the scores. Cronbach’s alpha and principal components analysis (PCA) were conducted on the observed Healthy Cooking Index items to examine patterns of cooking practices. RESULTS: Two main components of cooking practices emerged from the PCA: one focused on meat products and another on health and taste enhancing practices. The eButton was more accurate in collecting Healthy Cooking Index practices than the self-report questionnaire. Significant differences were found between participant reported and observed summative Healthy Cooking Index scores (p < .001), with no significant differences between scores computed from eButton images and observations (p=.187). CONCLUSIONS: This is the first study to examine nutrition optimizing home cooking practices by observational, wearable camera and self-report data collection methods. By strengthening cooking behavior assessment tools, future research will be able to elucidate the transmission of cooking education through interventions, and the relationships between cooking practices, disease prevention and health.

This article describes the processes employed to revise the widely used curriculum, Eating Smart • Being Active. Because of its popularity among nutrition education programs serving the low-income population, the curriculum developers felt it was important to share the revision process after the release of the 2015-2020 Dietary Guidelines for Americans. Extensive feedback during formative evaluation, updated content from the Dietary Guidelines for Americans, and a modern look resulted in a fully revised curriculum released in 2017. Program leaders should have confidence that their educators will be able to implement this evidence-based curriculum with fidelity. An outcome evaluation of the revised Eating Smart • Being Active curriculum is recommended.

Poor nutrition is a major risk factor for non-communicable diseases and nutritional deficiencies. Dietary interventions have been proposed to improve eating habits. The aim of this systematic review is to evaluate the efficacy of randomized clinical trials of nutritional interventions in food habits among older people. A systematic literature review using the MEDLINE, LILACS, Scopus, Cochrane Library, Web of Science and Google Scholar databases was conducted, according to PRISMA guidelines. The keywords were: food and nutrition education OR educación alimentaria y nutricional OR educação alimentar e nutricional AND clinical trial OR ensayo clínico OR ensaio clínico AND elderly OR aged OR anciano OR idoso AND human OR seres humanos. The pooled standardized mean differences (SMD) and 95 % confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity among studies was assessed using I² tests. After screening based on the title and abstract, and a full-text assessment, 11 studies remained. Results of pooling eleven studies were as follows: SMD = 0.25 (95 % CI = 0.15 - 0.34; I² = 0,0%) for vegetable, SMD = 0.18 (95 % CI = 0.08 - 0.27; I² = 0,0%) for fruit and SMD = 0.27 (95 % CI = 0.18 - 0.36; I² = 58,3%) for fibre intake. Our results suggest that nutritional interventions were effective in increasing vegetable, fruit and fibre intake. However, these results should be analyzed carefully, due to the small number of studies included in the meta-analysis. Further studies should be encouraged due to the aging process.

Objective This study aimed to assess nutrition status, nutrition knowledge, attitude, and practice of students residing in an Islamic boarding school in Indonesia. Methods Weight and height measurements were undertaken among 199 students. Self-administered questionnaires consisted of socio-demographic questions, as well as pre-tested questions concerning knowledge, attitude, and practice relevant to the Indonesian Dietary Guideline (balanced nutrition) were distributed. Descriptive analyses were undertaken to observe distributions of proportion of each nutritional status category by other measured variables. Results There were 24% underweight and 5% overweight students, with proportion of boys was greater than girls. The prevalence of stunting was 24% with more than half were boys. 12 out of 48 underweight students were stunted and one girl was stunted-and-overweight. 99% of students had insufficient knowledge regarding balanced nutrition, 21.6% had unfavourable attitude towards balanced nutrition, and 67% had less implemented practices of balanced nutrition. Conclusions Stunting, underweight, and problems in nutrition knowledge and practice, were quite high among adolescent students in this particular setting. Improvement of nutrition for this particular group of adolescent should be addressed through specific school-based nutrition education and intervention.

Introduction Malnutrition in the vulnerable groups of children and pregnant women was observed to be one of the major factors for child and maternal mortality. The study aimed at evaluating the nutritional status as well as underlying causes of malnutrition among children and pregnant women living in urban slums of Nongstoin Town, West Khasi Hills District, Meghalaya. Materials and methods A cross-sectional study design with time bound enumeration was conducted in the urban slum of Nongstoin among 420 under five children and 88 pregnant women from June–August 2018 using a semi-structured questionnaire quantifying the study objectives and standard assessment tools. The collected data was entered and analysed using SPSS (Statistical Package for the Social Sciences) version 16. Results Out of 420 participants 238(56.67%) children found severely malnourished and remaining 182(43.33%) of children were not in good health, most of them were found to have border line malnutrition and 49(55.68%) pregnant women were found to be moderate anaemic (Hb level:6–9 mg/dl) and 3(3.4%) pregnant women found to be having normal haemoglobin level (Hb > 12 mg/dl). Conclusion Poor health hygiene, inadequate sanitation and unsafe drinking water facilities were found to be the underlying causes of Malnutrition. Most of the children and pregnant women in the study were poor in nutritional status. There is an urgent need for developing a program such as skills-based nutrition education and healthy eating habit.

Background Rising rates of secondary traumatic stress and burnout among nurses signal a crisis in healthcare. There is a lack of evidence regarding effective interventions to improve nurse well-being and resiliency. Purpose This study used a randomized controlled trial parallel design to test the effectiveness of a 3-hour Community Resiliency Model® (CRM) training, a novel set of sensory awareness techniques to improve emotional balance. Methods Registered nurses in two urban tertiary-care hospitals were invited to participate, which entailed attending a single 3-hour “Nurse Wellness and Well-being” class; 196 nurses consented and were randomized into the CRM intervention or nutrition education control group to determine if the CRM group would demonstrate improvement in well-being and resiliency, secondary traumatic stress, burnout, and physical symptoms. Findings Pre/post data were analyzed for 40 CRM and 37 nutrition group members. Moderate-to-large effect sizes were demonstrated in the CRM group for improved well-being, resiliency, secondary traumatic stress, and physical symptoms. Participants reported using CRM techniques for self-stabilization during stressful work events. Discussion CRM shows promise as a brief resiliency training for hospital-based nurses.

Summary Background Primordial and primary prevention is the cornerstone for cardiometabolic health. In the randomised, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP; n=1116), a 20-year dietary counselling intervention was given to children biannually from infancy, and cardiometabolic health benefits had been observed among the participants in the intervention group. Here, we report on the key results of the first follow-up done 6 years after the end of the intervention, at age 26 years. Methods The randomised controlled STRIP study recruited children at age 5 months from well-baby clinics in Turku, Finland, and randomly assigned them to either an intervention or control group; group allocation was unmasked. The intervention introduced participants to a heart-healthy diet, characterised by low proportional intake of saturated fat and cholesterol, by dietary counselling and nutrition education sessions to parents and children from the age of 7 months to 20 years. Children in the control group received only the basic health education given at Finnish well-baby clinics and school health care. We assessed diet, lifestyle, and cardiometabolic risk factor data, including blood pressure, anthropometry, serum biochemistry (lipids, apolipoproteins, glucose, and insulin), and homoeostatic model assessment of insulin resistance (HOMA-IR) in the participants at age 26 years. Findings 1116 children were included in the original STRIP study, of whom 551 provided data at the age 26 years follow-up, and data for 507 participants were analysed (243 in the intervention group and 264 in the control group). At follow-up, those who had been in the intervention group had slightly lower mean intake of saturated fat as a proportion of total energy intake than the control group (13·0% [SD 3·3] vs 13·7% [3·6], p=0·049). A higher proportion of participants in the intervention group achieved the targeted monounsaturated and polyunsaturated fat to saturated fat ratio of more than 2:1 than the control group (78 [39%] of 200 vs 70 [30%] of 235; risk ratio [RR] 1·16 [95% CI 1·01–1·33]; p=0·035). A higher proportion of intervention group participants met the ideal total cholesterol concentration of less than 5·17 mmol/L (194 [81%] of 240 vs 187 [72%] of 261; RR 1·45 [1·05–2·01], p=0·024) and optimal LDL cholesterol concentration of less than 3·0 mmol/L (166 [69%] of 240 vs 158 [61%] of 251; RR 1·30 [1·03–1·66], p=0·031). Those who received the intervention had lower glucose (5·00 mmol/L [SD 0·43] vs 5·07 mmol/L [0·46], p=0·040) and HOMA-IR (median 1·44 [IQR 1·09–1·91] vs 1·62 [1·22–2·09], p=0·037) than the participants in the control group. Interpretation Previously observed intervention effects during the 20-year counselling were largely maintained into adulthood 6 years after the withdrawal of the intervention. Dietary counselling introduced in infancy thus provided a sustained benefit to diet quality and cardiometabolic risk factor levels. Funding Academy of Finland, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Finnish Ministry of Education and Culture, Finnish Cultural Foundation, Sigrid Juselius Foundation, Special Governmental grants for Health Sciences Research (Turku University Hospital), Yrjo Jahnsson Foundation, Finnish Medical Foundation, and Turku University Foundation.

Objective To develop and validate decision cases as a capacity-building training tool for implementing policy, systems, and environmental (PSE) change strategies. Design Study phases were: (1) in-depth interviews conducted repeatedly over a year with Supplemental Nutrition Assistance Program Education (SNAP-Ed) partner sites and once with SNAP-Ed implementers to identify dilemmas when implementing PSE change strategies; (2) decision cases developed to highlight dilemmas; and (3) focus groups with SNAP-Ed implementers to determine decision case utility as a capacity-building training tool. Setting A southeastern state. Participants SNAP-Ed partner sites and implementers; Focus group participants. Intervention Decision cases. Analysis To establish content validity, a thematic analysis of interviews identified common dilemmas when implementing PSE change strategies. SNAP-Ed implementers’ focus groups provided feedback to determine the utility and validity of decision cases developed from the analysis. Results Common dilemmas of implementation of PSE change strategies reported by SNAP-Ed partner sites (n = 20) and implementers (n = 8) were lack of site and educator readiness and capacity; communication breakdowns; and prioritization of nutrition education over PSE implementation. Focus group participants (n = 8) reviewed a case and discussion guide and recommended them as a capacity-building tool for training. Conclusions and Implications Using decision cases could help build SNAP-Ed implementers’ capacities to implement nutrition PSE change strategies and strengthen partnerships.

Objective To describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students. Design Prospective 5-year study following a pre-post intervention design. Setting Four elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools. Participants Approximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period. Intervention Healthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom. Main Outcome Measures Change in pre-post survey assessment of students’ nutrition literacy, attitudes, and intent; change in teachers’ self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria. Analysis Process evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.

Objective To explore undergraduate students self-reported learning experience in a foundation nutrition education course/unit delivered using a flipped classroom approach (FCA), which requires students to complete independent learning before and after interactive in-class learning experiences. Methods A descriptive cohort study design used selected items from a self-report flipped classroom student engagement questionnaire to assess Australian undergraduate student (n = 105) engagement in the course/unit and compared with nonflipped courses, preference for FCA, academic achievement, learning behaviors for 3 FCA learning phases, and more or less engaging aspects of the course/unit. Results Most (66.5%) students were engaged or very engaged, with half (55%) more engaged in this course/unit compared with other nonflipped courses/units with a preference for the FCA (53%). Almost half of the students agreed the FCA improved their academic performance (grade) (45%) and other academic skills (ie, teamwork) (48.5%). Most student comments related to the value of participate phase activities. Conclusions and Implications The FCA engaged most students in learning and is an emerging learning and teaching approach appropriate for undergraduate nutrition dietetic education.

Objective To explore perceived barriers to healthy eating within a food-insecure community that relies on an emergency food pantry. Methods A qualitative descriptive study was conducted using focus groups within an emergency food pantry located in southeastern Pennsylvania. Eleven female participants were recruited from the food pantry to serve as focus group participants and key community informants. Focus group transcripts were transcribed, coded, and analyzed using a constant comparative method. Results Four themes regarding perceived barriers to healthy eating were identified: (1) knowledge, (2) resources, (3) special dietary needs, and (4) culture and family influences. Conclusions and Implications Emergent themes from the focus groups identified the perceived barriers to healthy eating within a food-insecure community. These findings may be essential for informing the development of future nutrition education programs and for promoting health in low-income communities.

Objectives: To estimate the coverage of the National Vitamin A Supplementation Program (Programa Nacional de Suplementação de Vitamina A) in children from Alagoas, to identify factors associated with this coverage, and to analyze the adequacy of nutrition education actions. Methods: Household survey involving a representative probabilistic sample of children aged 6 to 59 months from Alagoas and their mothers (n = 509). Coverage was defined by the percentage of children with supplementation records in the last semester. The association between the independent variables (socioeconomic, demographic, and health) and the National Vitamin A Supplementation Program coverage was analyzed based on the prevalence ratio and its 95% CI. The mothers’ knowledge of questions related to vitamin A was considered as an indicator of the adequacy of nutrition education actions. Results: Program coverage was 91.9% in children aged 6-11.9 months and 38.6% in children aged 12-59 months. In the adjusted analysis, the factors that were associated with greater coverage were: age between 6-11.9 months (PR = 2.50, 95% CI: 2.10-2.96), living in rural areas (PR = 1.45, 95% CI: 1.20-1.76) and living in a house with ≤ 4 rooms (PR = 1.33, 95% CI: 1.09-1.63). Only 26.1% of the mothers were able to mention some food source of vitamin A and only 19.2% were aware of the consequences of vitamin deficiency for health. Conclusions: The National Vitamin A Supplementation Program coverage is below the targets set by the Ministry of Health (except for children

Objective To develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model. Design A randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program. Setting Study will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State. Participants Parents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states. Interventions FFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum. Main Outcome Measures Parents will report on feeding practices, child eating behaviors, feeding styles, and acculturation. Analysis Because of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.

Farm to school programs (F2SPs) operate in 42% of school districts and are supported in part through federal and state policies as well as philanthropic funding. Although research evaluating the effects of farm to school–related activities on student outcomes is growing, a systematic review of the results and thus a synthesis of implications for future programming have not occurred. The primary objective of this systematic literature review is to summarize and evaluate studies on student outcomes associated with farm to school–related activities up to 1 September, 2017. Four databases spanning 4 research disciplines were used to identify full-text, English-language studies. Twenty-one studies were reviewed: 7 explicitly investigated F2SPs, and 14 evaluated the impact of school-based interventions that were relevant to activities reported in the 2013 and/or 2015 Farm to School Census. All of the F2SP studies (n = 7) and 85.7% of farm to school–related activity studies (n = 12) were multicomponent, and there was a wide variety of implemented intervention components across the reviewed studies. Results from F2SP and farm to school–related activity studies consistently show positive impacts on food and nutrition-related knowledge; most studies also suggest a positive relation between farm to school–related activities and healthy food selection during school meals, nutrition self-efficacy, and willingness to try fruits and vegetables. The impact of farm to school activities on fruit and vegetable consumption and preferences is unclear. The most common F2SP study limitations were study designs that preclude causal inference, outcome measurement with no reported or limited psychometric testing, lack of long-term outcome evaluation, and challenges related to quantifying intervention implementation. These findings underscore the need for more conclusive evidence on the relation between farm to school–related activities and changes in fruit and vegetable consumption.

Current treatment for celiac disease (CD) requires a life-long gluten-free diet (GFD).1 Among the top challenges are eating outside the home2 and over-reliance on processed foods, which are often high-fat, low-fiber, and high-sugar.3 Home cooking is a GFD management strategy that addresses both. Research not specific to CD suggests a variety of positive outcomes related to home cooking: healthier dietary pattern, positive self-management behaviors (eg, improved glycosylated hemoglobin and cholesterol levels), increased willingness to integrate complex dietary changes, and improved quality of life (QOL).4-6 In this study we assessed the feasibility and acceptability of a cooking-based nutrition education intervention to promote GFD adherence and QOL among adults with CD.

Objective Supplemental Nutrition Assistance Program (SNAP)–authorized retailers’ healthy perceptions and store availability of healthy products were explored to plan a healthy food retail program. Methods Cognitive anthropology (free list) and quantitative (food environment measure) methods were used to assess retailers’ healthy product perceptions and the availability of store products aligned with dietary guidance. Cultural domain analysis techniques and descriptive and inferential statistics were used to interpret data. Results SNAP–authorized retailers (n = 29) of rural grocery (17%), dollar (14%), convenience (66%), and specialty (3%) stores participated. There was low salience for what constituted healthy and misalignments with dietary guidance and inventory. Dried beans, nuts, and seeds were widely available products across all stores and were listed less frequently by retailers. Conclusions and Implications Engagement with SNAP–authorized retailers to develop retailer-focused nutrition education and/or training protocols is warranted to improve the capacity for retailers to market store products aligned with dietary guidance.

Health systems and community organizations have increasingly offered nutrition education through teaching kitchens. With an increasing number of older adults (>65 years) accessing these programs, teaching kitchens may consider age-friendly adaptations to their standard curriculum. Based on experiences with implementing Healthy Teaching Kitchens Across Veteran Affairs Health Care System, and by applying the 5M Geriatric Care Framework (Mind, Multicomplexity, Medications, Mobility, What Matters Most), several steps are proposed for teaching kitchens to be able to better accommodate older adults.

Background People of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. Objective To identify what factors influence food purchasing decisions of low-income parents while food shopping. Design A qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. Participants and setting Twenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. Main outcomes Reasons for making decisions while food shopping. Analysis Audio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. Results A parent’s decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. Conclusion Understanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.