Availability of Food Options and Nutrition Education in Local Food Pantries.

OBJECTIVE: Explore the availability of food options and nutrition education at food pantries and identify the barriers to offering them to pantry clients. DESIGN: Cross-sectional, mixed-methods study. SETTING: Food pantry, Cincinnati, OH. PARTICIPANTS: A total of 41 food pantry coordinators (aged 63.4 ± 9.1 years), recruited by e-mail/phone in an urban area. PHENOMENON OF INTEREST: Availability of food options and nutrition education and barriers to improving food options and providing nutrition education at food pantries. ANALYSIS: Survey data were collected using Qualtrics and analyzed using SPSS software. In-depth interviews were transcribed verbatim, transcripts were independently coded, and codes and themes were discussed until a consensus was reached. RESULTS: The availability of fresh produce, dairy, low-sodium canned vegetables, and whole grains were limited, and 10 food pantries (24%) offered nutrition education to their clients. Challenges to improving food options were lack of space and equipment for storage and transportation. Identified barriers to providing nutrition education included the lack of space, funding, personnel with nutrition expertise, and clients' low interest in nutrition education. CONCLUSIONS AND IMPLICATIONS: The availability of healthy food choices and nutrition education were limited at local food pantries. Collaborative efforts with community partners and nutrition experts may be necessary to overcome those barriers.

Assessing the Digital Divide Among Low-Income Perinatal Women: Opportunities for Provision of Health Information and Counseling.

OBJECTIVES: Technology-based health interventions may provide a means to reach low-income perinatal women and improve outcomes for both mother and infant, yet little is known about technology access and interest among this population. This study explored interest, attitudes, and concerns regarding technology to deliver health information and interventions. METHODS: Between May and October 2014, a cross-sectional study of 161 low-income pregnant and/or postpartum mothers (up to 1 year) was conducted, assessing attitudes and behaviors regarding the current use of devices and receptivity to interventions delivered through devices. Participants (ages 18-41) were pregnant or postpartum and able to read and comprehend English. Women were recruited from waiting areas at two urban clinics affiliated with the local health department in a Midwestern city in the United States. Surveys included 46 questions and were completed at the time of invitation. Descriptive statistics, independent sample t test, or chi-square for independence tests were completed using SPSS (version 23). RESULTS: Participants from this sample were mostly African American (60%) and had a mean age of 26 years. Most were postpartum (67%). The majority of the sample used mobile phones (most being smartphones), with less access and use of computers and tablets. CONCLUSION: A moderate level of interest in utilizing technology for health-related information and interventions was found, with concerns related to privacy and time.

Docosahexaenoic Acid Supplementation in Pregnancy Modulates Placental Cellular Signaling and Nutrient Transport Capacity in Obese Women.

Context: Maternal obesity in pregnancy has profound impacts on maternal metabolism and promotes placental nutrient transport, which may contribute to fetal overgrowth in these pregnancies. The fatty acid docosahexaenoic acid (DHA) has bioactive properties that may improve outcomes in obese pregnant women by modulating placental function. Objective: To determine the effects of DHA supplementation in obese pregnant women on maternal metabolism and placental function. Design: Pregnant women were supplemented with DHA or placebo. Maternal fasting blood was collected at 26 and 36 weeks' gestation, and placentas were collected at term. Setting: Academic health care institution. Subjects: Thirty-eight pregnant women with pregravid body mass index ≥30 kg/m2. Intervention: DHA (800 mg, algal oil) or placebo (corn/soy oil) daily from 26 weeks to term. Main Outcomes: DHA content of maternal erythrocyte and placental membranes, maternal fasting blood glucose, cytokines, metabolic hormones, and circulating lipids were determined. Insulin, mTOR, and inflammatory signaling were assessed in placental homogenates, and nutrient transport capacity was determined in isolated syncytiotrophoblast plasma membranes. Results: DHA supplementation increased erythrocyte (P < 0.0001) and placental membrane DHA levels (P < 0.0001) but did not influence maternal inflammatory status, insulin sensitivity, or lipids. DHA supplementation decreased placental inflammation, amino acid transporter expression, and activity (P < 0.01) and increased placental protein expression of fatty acid transporting protein 4 (P < 0.05). Conclusions: Maternal DHA supplementation in pregnancy decreases placental inflammation and differentially modulates placental nutrient transport capacity and may mitigate adverse effects of maternal obesity on placental function.

Adiponectin and IGFBP-1 in the development of gestational diabetes in obese mothers.

OBJECTIVE: Gestational diabetes mellitus (GDM) is more common in pregnancies complicated by obesity and both diseases increase the risk for fetal overgrowth and long-term adverse health consequences for the mother and child. Previous studies have linked low maternal serum adiponectin to GDM in normal and overweight women. We hypothesized that lower adiponectin, in particular the high-molecular-weight form, and insulin-like growth factor I (IGF-I) and its binding protein (IGFBP-1) are associated with GDM in pregnant obese Hispanic women. METHODS: 72 obese, predominantly Hispanic (92%), women were recruited at 24-28 weeks of gestation. Adiposity was assessed, fasting serum samples were collected, and glucose, insulin, triglyceride, cholesterol levels, adipokines, and hormones associated with obesity and insulin resistance were measured. 30 women had been recently diagnosed with GDM. RESULTS: Gestational weeks, body mass index, triceps skinfold thickness, mid-arm circumference, serum leptin, IGF-I, tumor necrosis factor α, and interleukin-6 did not differ in the two groups. Obese women with GDM had significantly higher fasting glucose, A1C, triglycerides, very-low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol, adiponectin, and IGFBP-1 compared to obese women without GDM. Homeostasis model assessment of insulin resistance was positively correlated to IGF-I and negatively correlated to adiponectin. CONCLUSIONS: Obese pregnant women with recently diagnosed GDM had a significantly exacerbated metabolic profile, low serum adiponectin and IGFBP-1 levels at 24-28 weeks of gestation, as compared to women with obesity alone. Because low adiponectin is well established to cause insulin resistance and decreased IGFBP-1 indicates increased IGF-I bioavailability, we propose that these changes are mechanistically linked to the development of GDM in obese Hispanic women.

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association.

BACKGROUND: Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. METHODS AND RESULTS: For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies. CONCLUSIONS: This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Dietary factors affecting iron status of children residing in rural West Virginia.

This cross-sectional study was designed to determine the prevalence of iron deficiency among a group of infants (6 to 11.9 months) and toddlers (12 to 24 months) and to examine the relationship between dietary intake and iron status. Participants were recruited from WIC clinics in counties where the prevalence of anemia was high (>10%). Twenty-four hour recalls were used to determine dietary intake. Blood was analyzed for iron studies. Dietary factors were examined for their association with iron status using logistic regression analysis. No infants were iron deficient, but 12/39 (31%) toddlers were found to be iron deficient. Ferritin was significantly higher in infants compared to toddlers (44.2 microg/L v. 19.2 microg/L, p<0.001). Milk and calcium intakes were inversely associated with iron status. Each additional serving of meat increased the odds of normal iron status by about 30%. Meat intake may help to prevent iron deficiency during the transition to table foods.

Environmental perceptions related to physical activity in high- and low-risk counties.

To identify whether perceptions about the physical activity environment were related to the prevalence of sedentary lifestyle, residents from high-risk (n = 153) or low-risk (n = 100) counties were interviewed. County risk status was determined by the prevalence of cardiovascular mortality, overweight, and sedentary lifestyle. Key public officials in the same counties were also interviewed. Residents in the low-risk county were more likely to report having sidewalks in their community and that these sidewalks were safe and well lit than residents living in the high-risk counties. Low-risk county residents also reported more indoor recreation facilities being available than the residents in the high-risk counties. Residents supported allocating tax dollars toward improving sidewalks, lighting, and so on. Thus a more conducive environment for physical activity was found in the low-risk county. Improving physical environments and individual perceptions could help increase physical activity behavior.

Factors related to postpartum depressive symptoms in low-income women.

OBJECTIVE: This study examined the relationship of depressive symptoms to psychosocial and lifestyle variables in postpartum women. DESIGN: The Mothers' Overweight Management Study (MOMS) was a randomized, weight-gain prevention trial. Baseline data are presented on the Beck Depression Inventory (BDI), Perceived Stress Scale, Social Support Questionnaire, smoking status, body weight, waist circumference, and step counts. SUBJECTS/SETTING: The study was conducted at the Special Supplemental Feeding Program for Women, Infants, and Children (WIC). Women (N = 151) had to be over the age of 18 years and have a child under two years of age to participate. RESULTS: Fifty-one percent of the women (mean age = 27 years; mean of 30 weeks postpartum) reported depressive symptoms (27% mild, 21% moderate, and 3% severe). Overall, stress scores were high (Mean = 27.2) and activity levels low (Mean steps = 5984). Mean body mass index was 30.2. Neither body weight nor steps walked were related to depressive symptoms in the bivariate or regression analyses. However, stress and social support were related to symptoms. Women without symptoms reported significantly less stress than the mild and moderate/ severe symptom groups (Means = 23.4, 29.6, and 32.7, respectively, p <.001). Mean social support satisfaction was significantly higher for non-depressed women compared to women in the moderate/severe symptom range (Means = 5.9 and 4.7 respectively, p <.001). Stress and current smoking status explained 46% of the variance in depressive symptoms. CONCLUSIONS: These data emphasize the need for stress management and other tools such as increasing activity levels to prevent or lessen depressive symptoms.

The prevalence of heart-healthy menu items in West Virginia restaurants.

OBJECTIVE: To determine the prevalence of heart-healthy choices offered in restaurants. METHODS: Menus (N=273) were obtained from restaurants in the 10 most populated cities in West Virginia. A survey assessed the number of restaurants that provide point-of- purchase nutrition information and the heart-healthy choices offered. RESULTS: One restaurant offered point-of-purchase nutrition information. Nine percent of restaurants identified heart-healthy choices on their menus. There was a high frequency of offering vegetarian entrees, light side dishes, and vegetables; however, much less fruit, low-fat milk, low-fat salad dressing, or heart-healthy desserts were on menus. CONCLUSION: There is much opportunity for providing and identifying heart-healthy choices in restaurants.

Stages of change for weight management in postpartum women.

OBJECTIVE: This study examined factors related to stages of change for weight-management behaviors in postpartum women. DESIGN: Cross-sectional data, collected at baseline, are reported from the Mothers' Overweight Management Study (MOMS), a randomized, controlled trial conducted in postpartum women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).Subjects/Setting Subjects were a sample of WIC recipients (N=151) older than 18 years of age with a child younger than 2 years. Statistical analysis The dependent variables were the stages of change for weight-management behaviors (losing weight, avoiding high-fat foods, eating a high-fiber diet, and exercising). Demographic, health, and psychosocial variables were examined as independent variables. One-way analysis of variance was used to compare means, and chi(2) was used for proportions. RESULTS: Whereas 55% of women were in the action stage for weight loss, fewer women were in the action stage for the following weight management behaviors: avoiding high-fat foods (24%), increasing fiber (19%), and exercising three times per week (29%). Identifying pros for weight management was related to stages for losing weight, high-fat food avoidance, and exercise (F=13.4, P<.001; F=10.5, P<.001; F=3.7, P<.007, respectively). Self-efficacy for choosing a low-fat restaurant meal or using food labels was positively related to later stages for avoiding high-fat foods and increasing fiber intake (chi(2)=16.4, P=.003; chi(2)=11.7, P=.02). CONCLUSIONS: Emphasizing the pros for weight-management behaviors, decreasing the cons for exercising, increasing confidence to select low-fat restaurant choices, and improving skills for using food labels are four strategies that nutrition professionals can use to help women become more ready to change behaviors for weight management.

Effect of obesity on health-related quality of life among Appalachian elderly.

BACKGROUND: There is a paucity of research on health behaviors, health status, and overall health-related quality of life among Appalachian elderly. Identifying factors among older adults that place them at risk for low health-related quality of life is important for targeting unmet health needs and guiding community efforts to help improve population health. METHODS: For this study, we examined the relationship between obesity and health-related quality of life among Appalachians aged 65 years or older using the 2000 Behavioral Risk Factor Surveillance Survey data. RESULTS: Our results showed that obese elderly Appalachians report poorer self-rated health and more days of poor physical health compared with their nonobese counterparts. CONCLUSION: The goals put forward in Healthy People 2010 include the reduction of obesity and enhancement of quality of life. If such health disparities are to be eliminated and quality of life enhanced, a sustained effort to identify their determinants among Appalachian elderly is needed.

Focus groups on cardiovascular health in rural women: implications for practice.

OBJECTIVE: To determine rural women's perceptions about cardiovascular disease (CVD) prevention and behavior change for cardiovascular health. DESIGN: A trained moderator and nutritionist (observer) led the groups. The discussion guide was developed from the Health Belief Model and Social Cognitive Theory. The data were analyzed inductively looking at patterns and themes that emerged from the data and deductively looking at relationships from the theoretical models. SUBJECTS: Thirty-four white women participated in six groups: three younger (20-40 years; n = 18) and three older (40-55 years; n = 16) groups. Women with no more than 13 years of education were recruited by social service providers, Extension agents, and church groups. RESULTS: Rural women were unaware of their personal CVD risks. Common themes included the overriding influence of family preferences and cultural food patterns on women's food choices and the lack of support for adoption of a heart-healthy diet. Self-efficacy for dietary change spanned the continuum from no confidence (younger women) to complete empowerment (older women). CONCLUSIONS: Efforts need to be directed toward providing education and skill building for CVD prevention based on a better understanding of women's cultural beliefs and life situations. All women believed that dietary choices were important for cardiovascular health; however, they lacked the skills for food selection and preparation. Family preference and support are key to the adoption and maintenance of a heart-healthy eating plan. For interventions, women preferred active learning (hands-on experiences) coupled with group classes for learning and support. Rural women lacked these resources or access to a nutritionist.