Impact of an Infant Friendly Business Designation.

In response to suboptimal breastfeeding rates, North Dakota added a provision to SB 2344 (public indecency legislation) creating an Infant Friendly business designation for employers providing specified lactation accommodations to employees. However, there has been no evaluation of this designation to determine effectiveness. The purpose of this article is to examine the impact of the Infant Friendly business designation in North Dakota on breastfeeding continuation rates within the context of the social ecological model (SEM). Between November 2016 and March 2017, an 85-item online questionnaire, designed using the SEM, was distributed to working women across the state using various sampling methods. T tests, analysis of variance, and regression were used to analyze results. Designated (intervention) and nondesignated (control) businesses were targeted. There was no statistically significant difference in breastfeeding duration between designated and nondesignated businesses. There was a 2-month difference in duration between continually designated businesses and those with lapsing designations. Twenty-eight percent of the women working for Infant Friendly businesses were aware that their businesses were designated, indicating a lack of awareness regarding the designation. The designation is a starting point for worksite breastfeeding support. A policy promotion plan based on the SEM targeting individual awareness and employee education may improve the designation's effectiveness.

The high price of obesity in nursing homes.

This article provides a commentary on the costs of obese nursing home patients. We conducted a comprehensive literature search, which found 46 relevant articles on obesity in older adults and effects on nursing home facilities. This review indicated obesity is increasing globally for all age groups and older adults are facing increased challenges with chronic diseases associated with obesity more than ever before. With medical advances comes greater life expectancy, but obese adults often experience more disabilities, which require nursing home care. In the United States, the prevalence of obesity in adults aged 60 years and older increased from 9.9 million (23.6%) to 22.2 million (37.0%) in 2010. Obese older adults are twice as likely to be admitted to a nursing home. Many obese adults have comorbidities such as Type 2 diabetes; patients with diabetes incurred 1 in every 4 nursing home days. Besides the costs of early entrance into nursing facilities, caring for obese residents is different than caring for nonobese residents. Obese residents have more care needs for additional equipment, supplies, and staff costs. Unlike emergency rooms and hospitals, nursing homes do not have federal requirements that require them to serve all patients. Currently, some nursing homes are not prepared to deal with very obese patients. This is a public health concern because there are more obese people than ever in history before and the future appears to have even a heavier generation moving forward. Policymakers need to become aware of this serious gap in nursing home care.

Flaxseed supplementation improved insulin resistance in obese glucose intolerant people: a randomized crossover design.

BACKGROUND: Obesity leads to an increase in inflammation and insulin resistance. This study determined antioxidant activity of flaxseed and its role in inflammation and insulin resistance in obese glucose intolerant people. METHODS: Using a randomized crossover design, nine obese glucose intolerant people consumed 40 g ground flaxseed or 40 g wheat bran daily for 12 weeks with a 4-week washout period. Plasma inflammation biomarkers (CRP, TNF-α, and IL-6), glucose, insulin, and thiobaribituric acid reactive substance (TBARS) were measured before and after of each supplementation. RESULTS: Flaxseed supplementation decreased TBARS (p = 0.0215) and HOMA-IR (p = 0.0382). Flaxseed or wheat bran supplementation did not change plasma inflammatory biomarkers. A positive relationship was found between TBARS and HOMA-IR (r = 0.62, p = 0.0003). CONCLUSIONS: The results of the study weakly support that decreased insulin resistance might have been secondary to antioxidant activity of flaxseed. However, the mechanism(s) of decreased insulin resistance by flaxseed should be further determined using flaxseed lignan.

Differences in dietary patterns among college students according to body mass index.

OBJECTIVE AND PARTICIPANTS: The authors surveyed 557 undergraduate students aged 18-56 years to assess weight status, health behaviors, and dietary variety. METHODS: They used body mass index (BMI) to divide students into 4 weight categories: underweight (BMI < 19 kg/m2), healthy weight (19 kg/m2 to 24.99 kg/m2), over-weight (25 kg/m2 to 29.99 kg/m2), and obese (> 30 kg/m2). RESULTS: Approximately 33% of respondents were overweight or obese, and 8% were underweight. Among the weight categories, the authors observed significant differences in diet (eg, cheese, pork, lamb, veal and game, fish, green leafy vegetables, other vegetables, and the cumulative total of all meats). Overall, 33% of the students consumed 1 fruit in 3 days. The authors found no differences among the weight categories related to eating fatty, sugary snacks. CONCLUSIONS: College administrators should create health promotion and skill-building programs to improve students' diet variety.

Barriers and Strategies for Healthy Food Choices among American Indian Tribal College Students: A Qualitative Analysis.

BACKGROUND: American Indian and Alaskan Native individuals experience disproportionate levels of chronic health conditions such as type 2 diabetes and overweight and obesity that are influenced by dietary patterns and food choices. Understanding factors that influence healthy food choices among tribal college students can enrich education and programs that target dietary intake. OBJECTIVE: To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition. DESIGN: A nonexperimental cohort design was used for qualitative descriptive analysis. PARTICIPANTS/SETTING: Participants (N=20) were purposively sampled, newly enrolled, academically underprepared tribal college students enrolled in a culturally relevant life skills course at an upper Midwest tribal college between September 2013 and May 2015. Participant demographic characteristics included various tribal affiliations, ages, and number of dependents. MAIN OUTCOME MEASURES: Participant responses to qualitative research questions about dietary intake, food choices, self-efficacy for healthy food choices, psychosocial determinants, and barriers to healthy food choices during telephone interviews were used as measures. ANALYSIS: Qualitative analysis included prestudy identification of researcher bias/assumptions, audiorecording and transcription, initial analysis (coding), secondary analysis (sorting and identifying meaning), and verification (comparative pattern analysis). RESULTS: Qualitative analysis revealed a variety of themes and subthemes about healthy food choices. Main themes related to barriers included taste, food gathering and preparation, and difficulty clarifying healthy food choices. Main themes related to strategies included taste, cultural traditions and practices, and personal motivation factors. CONCLUSIONS: Qualitative analysis identified barrier and strategy themes that may assist nutrition and dietetics practitioners working with tribal/indigenous communities, tribal college educators and health specialists, and tribal community health workers who target health and dietary intake of American Indian and Alaskan Native students.

What's Age Got to Do With It? A Comparison of Bariatric Surgical Outcomes Among Young, Midlife, Older and Oldest Adults.

Bariatric surgery has become an accepted method to treat obesity and its related diseases in adults; nevertheless, few bariatric surgery follow-up studies compare changes in body mass index (BMI), disease outcomes, and side effects among age groups. This study compares bariatric surgery outcomes across four adult age groups by comparing changes in milestone BMIs such as highest and lowest BMI, perceived existing disease outcomes, and symptoms related to those diseases. Data were obtained using a 40-item questionnaire that was mailed to 2,520 patients of a Midwestern weight management center who were at least 18 months post-bariatric surgical procedure. The 534 respondents were divided into four age groups in years: 18 to 49 (n = 171), 50-59 (n = 148), 60-69 (n = 138), and ≥ 70 (n = 77). There were no differences among the age groups for lowest (p = .93) and current BMI (p = .51). Significant improvement in eight chronic diseases occurred across all age groups. There were no differences between age groups in reported occurrence of incontinence (p = .65), diarrhea (p = .22), flatulence (p = .46), heartburn (p = .73), and indigestion (p = .22). Constipation rarely occurred among the oldest adults (p < .001). Bariatric surgery should be considered an option for weight loss and disease management for older adults as much as it is for younger adults.

The Work behind Weight-Loss Surgery: A Qualitative Analysis of Food Intake after the First Two Years Post-Op.

Purpose. Obesity has reached epidemic proportions in the U.S. and has nearly doubled worldwide since 1980. Bariatric surgery is on the rise, but little focus has been placed on the psychosocial impacts of surgery. The purpose of this study was to explore experiences of patients who have undergone bariatric surgery at least two years before to gain an understanding of the successes and challenges they have faced since surgery. Methods. This study used a phenomenological approach, to investigate the meaning and essence of bariatric patients with food after surgery. Semi-structured interviews were conducted on a sample of nine participants who had undergone surgery at least two years prior. Findings. Two main themes regarding food intake emerged from the data: (a) food after the first year post-surgery and (b) bariatric surgery is not a magic pill. Upon further analysis, food after the first year post-surgery had four subthemes emerge: diet adherence after the first year post-surgery, food intolerances, amount of food, and tendencies toward coping with food do not magically disappear. Conclusion. Findings revealed that post-operative diet and exercise adherence becomes increasingly difficult as weight loss slows. Many participants find that only after the first year after surgery the work really begins.

Older adults fighting obesity with bariatric surgery: Benefits, side effects, and outcomes.

UNLABELLED: The aging population is growing exponentially worldwide. Associated with this greater life expectancy is the increased burden of chronic health conditions, many of which are exacerbated by the continued rise in obesity. In the US, the prevalence of obesity in adults aged 60 years and older increased from 23.6% to 37% in 2010. OBJECTIVES: This review examines bariatric surgery as a treatment option for obese adults > 60 years old. The most common types of weight-loss surgery are laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and the duodenal switch. METHODS: A comprehensive literature search found 349 articles that referred to bariatric surgery in older adults. Of these, 70 relevant articles on bariatric surgery for older adults were utilized for this article. RESULTS: Weight-loss surgery procedures were found to be equally safe for both older adults and their younger counterparts. Pre-surgical psychological assessment is critical for positive outcomes for older adults. Benefits of bariatric surgery include a decrease in comorbidities, chronic disease risk, and medication use coupled with improved mobility and quality of life outcomes. Side effects include surgical failure, changes in psychological status, and increased physical and mental stress. CONCLUSIONS: Bariatric surgery can offer patients an effective and long-lasting treatment for obesity and related diseases. There does not appear to be any one bariatric procedure that is recommended for older adults, so individual needs should be taken into consideration when exploring options. Costs range from US$17,000 for laparoscopic procedures to US$26,000 for open gastric surgeries. Estimated savings start accruing within 3 months of surgery making bariatric surgery a serious cost saving consideration.

Decreased consumption of sugar-sweetened beverages improved selected biomarkers of chronic disease risk among US adults: 1999 to 2010.

Consumption of sugar-sweetened beverages (SSBs) increased greatly from the late 1970s to the early part of this decade. Although recent data show that consumption of SSB may now be declining, consumption levels still remain much higher than recommended. Using data from the National Health and Nutrition Examination Survey, we assessed trends in intakes of SSB and levels of chronic disease biomarkers from 1999 to 2010 and examined the associations of SSB intake and biomarkers of chronic disease risk. We hypothesized that SSB intake will decrease and biomarkers of chronic disease risk will improve, therefore indicating that high intake of SSB is associated with greater chronic disease risk. Univariate analysis showed that from 1999 to 2010, SSB consumption decreased (P for trend = .0026), high-density lipoprotein increased (P for trend < .0001), low-density lipoprotein decreased (P for trend = .0007), and C-reactive protein decreased (P for trend = .0096). Using multivariate analysis, we showed that higher intakes of SSB were associated with lower high-density lipoprotein (P for trend < .0001), in an unadjusted model and all models with increasing numbers of covariates, and higher C-reactive protein (P for trend < .05), in an unadjusted model and in models with age, race/ethnicity, sex, education level, and poverty income ratio adjustments. We conclude that SSB consumption is associated with biomarkers of chronic disease risk, independent of demographic and lifestyle factors.

The influence of cartoon character advertising on fruit and vegetable preferences of 9- to 11-year-old children.

OBJECTIVE: The aim of the present study is to determine the influence of cartoon characters in preferences of fruit and vegetables among children. METHODS: A 10-item survey was used in this cross-sectional study to determine the factors that influence a child's likelihood of eating fruits and vegetables. Seven factors influencing consumption of fruits and vegetables were rank ordered by 218 third- and fourth-grade students. RESULTS: Results indicated that the child was more likely to eat fruits or vegetables if they tasted good, followed by whether they were nutritious. Presence of a cartoon character on the label ranked 6 of 7. Sex does not affect the rank order of factors that influence intake of fruits or vegetables. CONCLUSIONS AND IMPLICATIONS: Future interventions aimed at increasing consumption of fruits and vegetables should take into consideration such factors that influence intake.

Few associations between income and fruit and vegetable consumption.

OBJECTIVE: To examine the association between income and the consumption of fruits and vegetables using the poverty income ratio (PIR). DESIGN: Association between PIR and intake of fruits and vegetables combined. The PIR was divided into 5 groups ranging from < poverty threshold (PT) to ≥ 400% PT. PARTICIPANTS: Adults aged 18 years and older (N = 16,232) who participated in the 1999-2006 National Health and Nutrition Examination Survey and fit the qualifiers. MAIN OUTCOME MEASURES: The amount of combined fruit and vegetable intake based on income level. ANALYSES: Using ANCOVA, a base model with increasing number of covariates was analyzed. RESULTS: Mean daily intake ranged from 253-324 g for those who consumed both fruits and vegetables (N = 16,213). In the base model, significant differences in intake occurred between those who were at ≥ 400% PT and PIR groups < 400. When age, sex, race/ethnicity, and calorie intake were added to the base model, these differences remained. Adding educational level to the model removed these differences. CONCLUSIONS AND IMPLICATIONS: Dietary intake of fruits and vegetables is directly related to income when income reaches levels of ≥ 400% PT. These differences are mediated by education. Providing nutrition education may help individuals to reach the recommended level of consumption of fruits and vegetables.

Few favorable associations between fruit and vegetable intake and biomarkers for chronic disease risk in American adults.

Using 24-hour dietary recall data from the National Health and Nutrition Examination Survey 1999 to 2006, the possible link between fruit and vegetable intake and chronic disease risk was assessed. C-reactive protein (CRP), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), fasting plasma glucose (FPG), total cholesterol, and glycosylated hemoglobin were selected as biomarkers for chronic disease risk. It is hypothesized that individuals who consume more fruits and vegetables will have reduced chronic disease risk because of the healthful benefits of these foods. The objective of this study was to examine the relationship between fruit and vegetable consumption on selected biomarkers for chronic disease risk. Although some associations were significant for FPG, HDL-C, and low-density lipoprotein cholesterol in some of the models, no trend was present. After adjusting for demographic factors, socioeconomic factors, lifestyle factors, body mass index, total energy intake, and the presence of at least 1 of our 5 predetermined comorbidities, no associations of reduced or increased risk were observed in any quartiles of combined fruit and vegetable intake. Fruit and vegetable intakes were weakly associated with an increased HDL-C level and decreased FPG, glycosylated hemoglobin, and C-reactive protein levels in some of the models; however, no association was observed in the final model. Because selected biomarkers of future disease risk remained in reference ranges at both high and low intake and no significance was observed in the final model, no protective association was observed between fruit and vegetable intake and biomarkers for chronic disease risk. However, fruit and vegetable consumption is recommended as part of an overall healthy diet and to displace other energy-dense foods for weight maintenance, which can lead to a decrease in future disease risk.

Obesity and lifestyle in U.S. college students related to living arrangements.

The purpose of this paper is to determine if living arrangements influence dietary variety and other health behaviors among American college students. A generalized linear model was used to assess differences between students in various living arrangements. Results showed that off-campus students were more likely to be overweight/obese, consume more alcohol, and smoke than those who lived on-campus or with parents. Compared to students who lived off-campus, those who lived on-campus consumed a larger variety of fruits, vegetables, and dairy products. Those who lived off-campus consumed less variety of grains compared to those who lived with parents. There were no significant differences in variety of meat, meat alternatives, or snacks between the three groups. To prevent future chronic diseases, health educators should target off-campus students to improve dietary and lifestyle behaviors.

The ability of the DETERMINE checklist to predict continued community-dwelling in rural, white women.

This study evaluated the ability of the DETERMINE checklist to predict continued community-dwelling in rural elderly women. Using a stratified random sample (N = 249) of white women aged 65-94, in-home interviews were completed at baseline and a telephone interview at 3 years. Overall higher total DETERMINE checklist scores negatively predicted continued community-dwelling (p = 0.0005). Lower risk scores indicated continued community-dwelling, while mid-range scores were inconclusive. Regression analysis for each age bracket showed that total DETERMINE checklist scores was most predictive of those aged 75-84 (p = 0.0037). The DETERMINE checklist may be a useful tool to identify those with increased risk of losing independence.