Dietary Habits and Nutritional Knowledge of Pregnant Women: The Importance of Nutrition Education.

A good diet during pregnancy is associated with improvements to maternal and fetal health. Nevertheless, excessive weight gain during pregnancy has been reported in several studies. The aim of this review is to determine the dietary habits of pregnant women (measured according to their degree of adherence to the Mediterranean diet, a reference in dietary quality), their knowledge of food and nutrition, and their perceptions of the nutritional education received during their pregnancy, in order to detect intervention needs within that group. The bibliographic search was conducted on three databases (Medline, PubMed central, and Web of Science), using the keywords "pregnancy", "Mediterranean diet", "nutrition knowledge", "nutritional education", and some synonyms. The final selection included 68 original articles. The available evidence indicated that, although pregnant women were aware of the importance of nutrition during pregnancy, their habits showed some room for improvement in terms of diet and physical exercise. Lack of adequate advice was the main barrier to the practice of healthy habits that pregnant women encountered; they considered that the information they received during pregnancy follow-up visits was inadequate. However, the success of interventions within different countries is a source of hope for well-structured nutrition education throughout pregnancy. The lack of nutrition-related knowledge among pregnant women could be originally related to poorly planned nutrition education from healthcare providers. Research focused on the consultations with these healthcare providers could be of help when proposing strategies to improve the content, the depth, and the duration of nutrition education sessions. It should, in any case, be noted that the available evidence in this field is limited to certain geographical origins. Therefore, research that uncovers evidence in different countries will be useful for learning about the factors that condition the habits of pregnant women and, in that way, guide strategies for the improvement of the health of expectant mothers during that stage in their lives.

Nutritional Nesting (Nestrition): Shaping the Home Food Environment in the First Pregnancy.

OBJECTIVE: To investigate primiparous women's knowledge, attitudes, and practices regarding the physical home food environment (PHFE) and to assess if the first pregnancy provides a teachable opportunity to enhance the PHFE of first-time pregnant couples. DESIGN: Longitudinal in-depth qualitative study involving questionnaires and individual interviews during and after pregnancy. PARTICIPANTS: Fifteen primigravida women. MAIN OUTCOME MEASURES: Knowledge, attitudes, and behaviors concerning PHFE; lifestyle and dietary habits; and interest in guidance regarding healthy PHFE during the first pregnancy and the transition to motherhood. ANALYSIS: Thematic analysis for qualitative data and descriptive statistics. RESULTS: Key findings include the significance of health, nutrition, and spousal support in the transition to motherhood. The first pregnancy was recognized as a critical period for establishing a healthy PHFE, while noting the physical and emotional challenges involved. A gap was found in guidance regarding PHFE for first-time pregnant women despite their interest in practical advice. CONCLUSIONS AND IMPLICATIONS: The first pregnancy presents a significant opportunity to improve PHFE. 'Nestrition' (nutritional nesting), a new health-promotion strategy, incorporates nutrition education to enhance this process. These data support future research encompassing partners and diverse at-risk populations prior to the development of effective nutrition education for PHFE in the first pregnancy.

Impact of a Nutrition and Diabetes Continuing Education Program on Primary Care Provider's Knowledge, Attitude, and Clinical Practice.

Purpose: Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition. Methods: At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program. Results: In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only physician efficacy was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05). Conclusion: An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.

A virtual culinary medicine intervention for ethnically diverse individuals with type 2 diabetes: development of the Nourishing the Community through Culinary Medicine.

Virtual culinary medicine education interventions have the potential to improve dietary behaviors, nutrition knowledge, cooking skills, and health outcomes for ethnically diverse individuals with type 2 diabetes. The purpose of this study is to describe the adaptation of the Nourishing the Community through Culinary Medicine (NCCM) program for virtual delivery, and the protocol for pilot testing this intervention. The intervention includes five 90-min virtual NCCM sessions streamed live from a Teaching Kitchen. Feasibility outcomes are recruitment, retention, acceptability, and satisfaction. Short-term effectiveness outcomes are measured through self-administered questionnaires, including perceived health, average daily servings of fruits and vegetables, frequency of healthy food consumption, shopping, cooking, and eating behaviors, cooking self-efficacy, diabetes self-management, perceived barriers to healthy eating, and nutrition knowledge. Demographics and biometric outcomes are sourced from the patient's electronic medical records including glycosylated hemoglobin (HbA1c), Body Mass Index, and blood pressure. We will conduct a single-arm pilot study to test the feasibility and short-term effectiveness of NCCM program with individuals with type 2 diabetes.

A Proposed Cost-Benefit Analysis of Adult EFNEP Utilizing Biomarkers of Chronic Disease Risk.

OBJECTIVE: To assess whether the adult Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective intervention that generates sustained improvement in biomarkers of chronic disease risk. DESIGN: A longitudinal quasi-experimental design with 2 parallel arms (untreated comparison vs EFNEP) and 4 waves of data collection (pretest, posttest, 6 months, and 12 months after completion). SETTING: Eligible adult EFNEP community settings in Colorado, Florida, Maryland, and Washington. PARTICIPANTS: Free-living adults (n = 500) aged 18-50 years, with income ≤ 185% of the Federal Poverty Line. INTERVENTION(S): Adult EFNEP delivered using an evidence-based curriculum, Eating Smart • Being Active. MAIN OUTCOME MEASURE(S): Chronic disease biomarkers (body mass index, blood pressure, and HbA1c), food and physical activity behaviors, dietary intake, health status, and demographics will be measured using objective biometric indicators, the Adult EFNEP Questionnaire, a 24-hour dietary recall, a health questionnaire, and demographic forms. ANALYSIS: Linear mixed models will be used to assess whether adult EFNEP has a significant (P < 0.01) impact on 3 chronic disease biomarkers. The program's estimated impact on chronic disease biomarkers will be incorporated into a cost-benefit analysis framework to assess the economic value generated by adult EFNEP through chronic disease risk reduction.

Teacher perspectives on the socio-ecological barriers and enablers to food and nutrition education in primary schools: a scoping review.

OBJECTIVE: Schools are identified as a setting for food and nutrition education (FNE) in childhood. FNE is a key strategy to optimise child growth and development and impart life-long food skills. There is limited synthesis of the literature to understand the socio-ecological determinants of teachers and schools engaging in FNE. DESIGN: For this scoping review, five databases (APA PsycInfo, ERIC, Medline, CINAHL and Scopus) were searched using the terms (and synonyms for) primary school teacher, self-efficacy and food and nutrition. A quality assessment using relevant Johanna Briggs tools was carried out for the included papers. Data were extracted using a modified socio-ecological model, and narrative themes were identified. SETTING: Primary (elementary) schools in high-income countries. PARTICIPANTS: Primary-school teachers. RESULTS: Forty-one papers were included in this review from ten countries (predominantly the USA). The narrative synthesis identified five themes that interact with teacher delivery of FNE. These were (i) perceived food and nutrition responsibilities of teachers, (ii) teacher beliefs and self-efficacy, (iii) opportunities to build teacher nutrition knowledge and self-efficacy, (iv) interpersonal contributors and (v) broader environmental, structural and policy contributors. CONCLUSIONS: Multiple strategies are needed to build the capacity of teachers to undertake FNE within primary school settings. These strategies include a focus on learner-centred education that will build teacher agency, school leadership, ensuring the health and well-being of teachers and providing initial teacher education as well as innovative professional development for cross-curriculum integration. Strategies drawing from each level of the socio-ecological framework will increase opportunities for capacity building.

Pilot Study Assessing the Baseline Physical Activity and Knowledge of Heart Health of Elementary School-Aged Children in Rural South Carolina and the Impact of an Interactive Educational Program.

PURPOSE: This study asked whether, if provided with education on heart-healthy habits, elementary school children in Abbeville, Greenwood, and Saluda counties in South Carolina would retain and desire to implement healthy nutrition and increased exercise. We hypothesized that teaching children about heart-healthy habits would increase their activity levels and improve their desire to be active. METHODS: This was a longitudinal survey study. Children at local after-school programs were given a pre-survey, the Kids' Activity and Nutrition Questionnaire (KAN-Q), to assess their activity levels, diet, and knowledge of heart health. The children had a 15-minute educational period followed by an interactive program. Students completed the same survey at each of the three sessions. FINDINGS: A total of 44 children answered the survey questions at the beginning of each session. Out of the 10 behavioral questions, six indicated a favorable shift towards adopting healthier habits. Whole grain consumption increased to 71% from 32% (p<0.01). Vegetable consumption increased from 39% to 88%, and fruit consumption increased from 68% to 92% (p<0.01). There was a 30% decrease in the consumption of sugary drinks (p<0.01), and a reduction in hours watching television (p=0.05). All four knowledge-based questions had an increase in correct responses across the three sessions (p<0.01). CONCLUSION: To augment behavior, a dual approach of education on nutrition and exercise leads to improved nutrition choices and exercise habits for primary prevention of cardiovascular risk factors in elementary school-aged children. These habits improve adherence to increased physical activity and better nutrition after school.

A Scoping Review of Food Literacy Interventions.

INTRODUCTION: Food literacy (FL) is a rapidly emerging area of research that provides a framework to explain the interplay of food-related skills, beliefs, knowledge and practises that contribute to nutritional health and wellbeing. This review is the first to scope the current literature for FL interventions, assess their characteristics against the components provided in the most widely cited definition of FL. and describe their characteristics to identify gaps in the literature. METHODS: This review scopes original articles describing FL interventions in the Medline, CINAHL, ProQuest Education, Web of Science and AMED databases up to August 2023. RESULTS: Despite the heterogeneity between all seven included studies, they all demonstrated some improvements in their FL outcome measures alongside dietary intake (DI), with the greatest improvements seen in studies that employed a FL theoretical framework in intervention design. Populations at high risk of food insecurity, such as university students and people living in disadvantaged areas, were the main targets of FL interventions. CONCLUSION: The minimal inclusion of FL theory amongst interventions led to an overall poor coverage of essential FL components, indicating researchers should aim to design future FL interventions with a FL theoretical framework.

Nutrition in Educational Institutions-The Perspective of School Principals and Parents on the Tasks of Local Governments (Poland).

BACKGROUND: The financing of nutrition in educational institutions is one of the cornerstones of the activities of local governments in Poland. Proper management of this area is crucial to ensuring that children and young people have access to wholesome meals, which directly affects their health, physical development, as well as educational effectiveness. OBJECTIVE: This study aimed to examine how school principals and parents perceive the role of local governments in managing school nutrition in Poland, given the growing importance of nutrition programs for children's health. METHODS: A survey was conducted with 200 school principals and 1000 parents, assessing satisfaction with the implementation, quality, and organization of nutrition programs overseen by local authorities. RESULTS: The results revealed significant differences between the two groups. While 75% of principals expressed satisfaction with the quality of meals provided in schools, only 55% of parents shared this view. Similarly, 80% of principals rated the organization of cooperation with food suppliers positively, compared to only 50% of parents. Regarding allergen information, 65% of principals felt adequately informed, while only 30% of parents agreed. These differences were statistically significant in several key areas, including adherence to nutrition standards (p = 0.009), frequency of health inspections (p = 0.009), and availability of allergen information (p = 0.013). CONCLUSIONS: The findings highlight a need for improved communication and collaboration between schools, parents, and local governments to enhance the effectiveness of nutrition programs. It is recommended that regular informational meetings be held and that the flow of information be improved to increase parental satisfaction and the overall effectiveness of school nutrition initiatives.

Non-alcoholic fatty liver disease: The importance of physical activity and nutrition education-A randomized controlled study.

BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD) is characterized by the accumulation of excess fat in the liver, causing liver cell damage, increased inflammation, and weight gain. Despite its high prevalence, diagnosis and follow-up of the disease is difficult. Irisin, a slimming myokine produced in response to physical activity (PA), exhibits anti-inflammatory and anti-obesity effects. This study aimed to investigate changes in irisin levels, inflammation markers (tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6]), and myeloid differentiation factor-2 (MD2) levels in NAFLD, as well as anthropometric and routine biochemical parameters, by providing PA recommendations and nutrition education (NE) to individuals diagnosed with NAFLD over a period of 12 weeks. METHODS: The study included 62 patients diagnosed with NAFLD who did not use alcohol. They were divided into groups: PA, NE, both (NE + PA), and untreated (control) patients. Patients receiving NE were provided with 1-h NE sessions every 4 weeks for 12 weeks, and their personal information, nutritional status, 24-h retrospective food consumption record, and anthropometric measurements were recorded at the beginning (day 0) and end (week 12) of the study. The PA group was recommended aerobic walking for 30 min, 5 days a week. At the beginning (day 0) and end (week 12) of the study, patients' anthropometric and routine biochemical tests were conducted, and irisin, MD2, TNF-α, and IL-6 levels were measured using the ELISA method. RESULTS: All groups were similar in demographic characteristics and dietary habits. After 12 weeks, there were no significant differences in biochemical parameters among the groups. Glucose levels increased in the untreated group but decreased in the PA and PA + NE groups compared to baseline, with a significant decrease in the PA group. Insulin levels significantly decreased in the NE group. The PA + NE group showed decreased aspartate aminotransferase (AST), gamma-glutamyl transferase, alkaline phosphatase, total cholesterol, low-density lipoprotein, and triglyceride levels and significant decrease in ALT levels. AST decreased significantly in the PA group while high-density lipoprotein increased significantly. There were no statistically significant differences between the groups in irisin, MD2, IL-6, and TNF-α levels. After 12 weeks, irisin levels significantly increased in nutrition and PA groups except the untreated group. There were no statistically significant differences in IL-6 and MD2 levels compared with baseline after 12 weeks. PA recommendations alone were not effective in observing significant changes in anthropometric measurements in individuals with NAFLD. It was detected that only nutritional recommendations provided a significant decrease in body fat ratio but were insufficient for the change in other anthropometric measurements. In the group where NE and PA were recommended together, a significant decrease in anthropometric measurements was found. The NE group significantly reduced their energy and carbohydrates (%EI) intake after 12 weeks of intervention compared with the baseline. CONCLUSION: NE and PA recommendations led to improvements in liver-related biochemical parameters and significant reductions in anthropometric measurements among individuals with NAFLD. Moreover, patients receiving NE experienced a decrease in energy and carbohydrates intake as a percentage of total energy intake (%EI). Increased irisin levels in NE, PA, and NE + PA groups may have contributed to the decrease in body fat percentage.

Effectiveness of a nutrition education intervention using simulation videos and encouragement of parental involvement for elementary school students.

This study aims to develop a nutrition education intervention to promote healthy eating, and to evaluate the effectiveness of this intervention on healthy eating knowledge, attitude and behaviour among elementary students. A quasi-experimental study was conducted in two elementary schools in Taiwan. The intervention course design included simulation videos, lectures, and the after-school learning worksheet designed for parental involvement. A total of 4 courses along with 4 simulation videos were given to the intervention group. The four course themes were Sugar patrol, Balanced Diet during the Mid-Autumn Festival, Rainbow Fruit and Vegetables, and Smart Dine Out. The study recruited 35 3rd grade students for the intervention group and 30 for the control group. Data were collected from the pre- and post-test questionnaires. The nutrition intervention had significant effects on improving participants' knowledge about tips for making healthy choices and the necessity of balanced diet, and on attitude toward healthy eating. There was no significant improvement in participants' healthy eating behaviours. This nutrition education intervention, which utilized simulation videos and encouraged parental involvement, could be recommended for teaching practice in elementary schools to improve healthy eating knowledge and attitude among students.

Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability.

BACKGROUND: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. OBJECTIVE: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. METHODS: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. RESULTS: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention's concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. CONCLUSIONS: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT.

Evaluation of the Effect of Nutrition Education on Osteopathic Medical Students' Personal Nutrition Choices and Incorporation Into Future Medical Practice.

CONTEXT: Our current research project evaluates the impact of nutrition education on the medical student's personal nutrition goals and the likelihood of incorporating nutrition needs into patient evaluation and treatment plans in future practice. The growing popularity of lifestyle medicine has further emphasized the importance of nutrition in the treatment of all patients, especially those suffering from chronic diseases. The paucity of formal medical nutrition education in medical school curricula leaves a significant gap in the knowledge base of physicians in practice. OBJECTIVE: In an attempt to close the gap, we increased nutrition education in first-year osteopathic medical students by establishing a nutrition course emphasizing modern competencies and their importance in clinical practice.  Methods: The course evaluation utilized a two-group quasi-experimental pre-test/post-test study design. The intervention group consisted of medical students participating in the newly established course, and the control group consisted of second-year medical students who had not taken the course as part of their curriculum. Information was collected about students' knowledge, attitudes, behaviors around nutrition, their plans to pursue a residency with a focus on culinary medicine and incorporate medical nutrition into their medical practice in the future, and their intention to incorporate culinary medicine into future treatment plans. Participation rates within a voluntary culinary medicine interest group were also tracked. RESULTS:  Students in the intervention group were 26% more likely to report that proper nutrition for patient care had been addressed in coursework. This suggests that medical students exposed to the medical nutrition course have received more training that is critical in proper patient care than students in the control group. Students in the intervention group were 93% more likely to believe that proper nutrition can be used to prevent disease. Lastly, significantly more students in the intervention group (33% more) intend to explore residency programs with a focus on culinary medicine than those students in the control group. CONCLUSION: These results demonstrate that nutritional education promotes an awareness of the effectiveness of nutritional counseling in disease prevention and management. Furthermore, it will hopefully prompt future physicians to consider nutritional counseling during their clinical rotations, through residency, and into their independent practice. The presentation of nutrition in the first year of medical school is critical to develop increasing numbers of primary care physicians that promote the importance of nutrition and a healthy lifestyle for patients.

Development and Validation of a Micronutrients Knowledge, Attitudes, and Practices Questionnaire for Adolescents Using Psychometric Analysis.

Introduction The development of a questionnaire that measures knowledge, attitude, and practices towards micronutrients will help to develop nutrition intervention programs. The present study aimed to develop and assess the validity and reliability of a questionnaire on knowledge, attitude, and practices (KAP) on micronutrients in adolescents in India. Methods A total of 150 adolescent girls participated in the study. The literature was reviewed to formulate an initial draft of a questionnaire (122 items). Face and content validity were measured by participants and subject experts, respectively, and the content validity index was calculated. Construct validity was assessed using the principal component method of exploratory factor analysis. Internal consistency and test-retest reliability were determined by Cronbach's α value and interclass correlation coefficient correlations, respectively. Results The content validity index for all items except eight items from the practice subscale was satisfactory. Face validity results showed that participants understood all items. Exploratory factor analysis suggested a four-factor construct (perceived susceptibility and severity, perceived benefits, readiness to change, and perceived barrier) in the attitude subscale. Internal consistency for knowledge, attitude, and practice items were 0.980, 0.840, and 0.930, respectively. For knowledge and attitude items, interclass correlation coefficient correlation estimates ranged between 0.705 to 0.987 and 0.775 to 0.997, respectively, whereas for practice items, it ranged from 0.701 to 0.945. In the final questionnaire, 134 items consisting of 33 knowledge, 21 attitudes, and 80 practices (55 dietary practices and 25 other practices related to micronutrients) were included. Conclusion The results provided evidence of the validity and reliability of the questionnaire on micronutrients and that can be used to assess the knowledge, attitude, and practices on micronutrients in adolescents. Further studies in different diverse settings are recommended.

Effect of nutrition education on the nutritional status of pregnant women in Robe and Goba Towns, Southeast Ethiopia, using a cluster randomized controlled trial.

Maternal malnutrition is pervasive throughout the world, notably in sub-Saharan Africa (SSA), including Ethiopia. This study aimed to assess the effect of nutrition education on the nutritional status of pregnant women in urban settings in Southeast Ethiopia. A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control). We used a multistage cluster sampling technique followed by systematic sampling to select the pregnant women. Pregnant women who participated in the intervention arm received six nutrition education sessions. Women in the control group received standard care. A nonstretchable mid-upper arm circumference (MUAC) tape was used to measure the MUAC. A linear mixed effects model (LMM) was used to evaluate the effect of the intervention on MUAC, accounting for the clustering. The net mean ± standard error of MUAC between the intervention and control groups was 0.59 ± 0.05 (P < 0.0001). The multivariable LMM indicated that having received nutrition education interventions (ß = 0.85, 95% CI 0.60, 1.12, P < 0.0001) improved the MUAC measurement of pregnant women. Thus, nutrition education during pregnancy will combat undernutrition among pregnant women.Trial Registration: Clinicaltrials.gov (PACTR202201731802989), retrospectively registered on 24/01/2022.

Feasibility of a co-designed online nutrition education program for people with multiple sclerosis.

OBJECTIVE: Diet quality is important for people with multiple sclerosis (MS), but conflicting online information causes them confusion. People with MS want evidence-based MS-specific information to help them make healthy dietary changes, and we co-designed an asynchronous, online nutrition education program (Eating Well with MS) with the MS community. Our aim was to determine the feasibility of Eating Well with MS. METHODS: We used a single-arm pre-post design. The feasibility trial was a nine-week intervention with adults with confirmed MS. Feasibility outcomes: 1) demand (recruitment); 2) practicality (completion); 3) acceptability (Intrinsic Motivation Inventory: interest/enjoyment and value/usefulness subscales); and 4) limited efficacy testing (Diet Habits Questionnaire (DHQ); Critical Nutrition Literacy Tool (CNLT); Food Literacy Behaviour Checklist (FLBC), using intention-to-treat analysis). RESULTS: Recruitment (n = 70) exceeded the target (n = 48) within six weeks. Of the 70 enrolled, 84 % completed at least one module and 54 % completed the full program (five modules). The median interest/enjoyment rating was 5 out of 7 and median value/usefulness rating was 6 out of 7 (where 7 = 'very true'). Compared to pre-intervention, DHQ, CNLT, and FLBC scores all statistically significantly improved post-intervention. CONCLUSION: Eating Well with MS was well received by the MS community and improved their dietary behaviours; demonstrating feasibility. Our findings support the use of co-design methods when developing resources to improve dietary behaviours.

Evaluating Experiences in a Digital Nutrition Education Program for People With Multiple Sclerosis: A Qualitative Study.

BACKGROUND: Multiple sclerosis (MS) is a complex immune-mediated disease with no currently known cure. There is growing evidence to support the role of diet in reducing some of the symptoms and disease progression in MS, and we previously developed and tested the feasibility of a digital nutrition education program for people with MS. OBJECTIVE: The aim of this study was to explore factors that influenced engagement in the digital nutrition education program, including features influencing capability, opportunity and motivation to change their dietary behaviours. METHODS: Semi-structured interviews were conducted with people who had MS, and who completed some or all of the program until data saturation was reached. Interviews were analysed inductively using thematic analysis. Themes were deductively mapped against the COM-B (Capability, Opportunity, Motivation, Behaviour) behaviour change model. RESULTS: Sixteen interviews were conducted with participants who completed all (n = 10) or some of the program (n = 6). Four themes emerged: (1) acquiring and validating nutrition knowledge; (2) influence of time and social support; (3) getting in early to improve health and (4) accounting for food literacy experiences. DISCUSSION: This is the first online nutrition program with suitable behavioural supports for people with MS. It highlights the importance of disease-specific and evidence-based nutrition education to support people with MS to make dietary changes. Acquiring nutrition knowledge, coupled with practical support mechanisms, such as recipe booklets and goal setting, emerged as crucial for facilitating engagement with the program. CONCLUSIONS: When designing education programs for people with MS and other neurological conditions, healthcare professionals and program designers should consider flexible delivery and building peer support to address the needs and challenges faced by participants. PATIENT OR PUBLIC CONTRIBUTION: Members of the MS Nutrition Research Program Stakeholder Reference Group, which includes people with MS and MS health professionals, provided input during the development of the nutrition education program and study design stages.

Standardizing Dietary Recall: A Necessity for the Expanded Food and Nutrition Education Program.

This report explores the 24-hour dietary recall (24HDR) form used for the Expanded Food and Nutrition Education Program (EFNEP). Dietary supplement use, amount of money spent on food, time being physically active, portion size consumed, foods reported by meals, and preparation of the meal were common components collected among 61 EFNEP programs. Components not included were instructions for the peer educator, use of food models/measuring cups, examples of foods/beverages, time food/beverages were consumed, color coding, and a prompt to review what was written. A standardized 24-hour dietary recall form with training protocols is recommended to uphold the integrity of data collection.

Importance of an Ongoing Nutritional Counselling Intervention on Eating Habits of Newly Diagnosed Children with Celiac Disease.

A strict lifelong gluten-free diet (GFD) is the current treatment for the management of celiac disease (CD). Several studies have demonstrated that without proper dietary assessment, this diet leads to nutritional deficiencies and/or imbalances. The present study aimed to improve the dietary habits of newly diagnosed children with CD through ongoing and face-to-face dietary counseling. Forty-three participants were followed during the first year after CD diagnosis. Dietary data were collected at diagnosis (Vt0), after 3 months on a GFD (Vt3), and after 1 year following a GFD (Vt12). Participants completed a 3-day 24-h food recall, a food frequency questionnaire, and the KIDMED index. After each data collection, participants received dietary assessment and nutritional education. Participants consumed more plant-origin foods after the intervention, with most of them reaching the daily recommendations. Fresh food intake increased and that of ultra-processed foods decreased. Compliance with the Mediterranean diet also improved. Personalized dietary assessment and ongoing follow-up improved the dietary patterns of children recently diagnosed with CD, highlighting the importance of dietitian involvement in the management of CD.