Educational video intervention improves knowledge and self-efficacy in identifying malnutrition among healthcare providers in a cancer center: a pilot study.

PURPOSE: Cancer is the second leading cause of death in the USA, and malnutrition secondary to cancer progression and treatment side effects is common. While abundant evidence indicates that nutrition support improves patient outcomes, it is estimated that up to half of malnutrition cases are misclassified or undiagnosed. The use of a multidisciplinary team to assess nutrition status has been observed previously to reduce delays in nutritional support. Hence, educating all members of the oncology healthcare team to assess nutrition status may encourage earlier diagnosis and lead to improved patient outcomes. Thus, the objective was to perform a pilot study to assess change in knowledge and self-efficacy among oncology team members after watching an educational video about malnutrition. METHODS: A pre-test post-test educational video intervention was given to 77 ambulatory oncology providers during weekly staff meetings at a community ambulatory oncology center in central Illinois. Change in knowledge and self-efficacy in malnutrition assessment and diagnosis was measured and acceptability of the brief educational video format was also observed. RESULTS: Mean test scores improved by 1.95 ± 1.48 points (p < 0.001). Individual occupational groups improved scores significantly (p ≤ 0.005) except for specialty clinical staff. Self-efficacy improved from 38 to 70%. 90.8% of participants indicated the educational video improved their confidence in assessing malnutrition. CONCLUSIONS: The educational video was well accepted and improved knowledge and self-efficacy of malnutrition assessment and diagnosis among ambulatory oncology providers. Wider implementation of such an educational intervention and longitudinal testing of knowledge retention and behaviors change is warranted.

Weight Status and Visceral Adiposity Mediate the Relation between Exclusive Breastfeeding Duration and Skin Carotenoids in Later Childhood.

BACKGROUND: Breastfeeding is associated with healthier weight and nutrient status in early life. However, the impact of breastfeeding on carotenoid status beyond infancy, and the influence of adiposity, are unknown. OBJECTIVES: The aim of the study was to retrospectively investigate the relation between breastfeeding and carotenoid status, and the mediating effect of weight status and adiposity on this relation, among school-age children. METHODS: This was a secondary analysis of baseline data collected from a randomized-controlled clinical trial. Children 7-12 y old (n = 81) were recruited from East-Central Illinois. DXA was used to assess visceral adipose tissue (VAT) and whole-body total fat percentage (%Fat; i.e., whole-body adiposity). Weight was obtained to calculate children's BMI percentiles. Skin carotenoids were assessed via reflection spectroscopy. Macular carotenoids were assessed as macular pigment optical density (MPOD). Dietary, birth, and breastfeeding information was self-reported by parents. RESULTS: Skin carotenoids were inversely related to %Fat (P < 0.01), VAT (P < 0.01), and BMI percentile (P < 0.01). VAT and BMI percentile significantly mediated this relation between exclusive breastfeeding duration and skin carotenoids, after adjustment for dietary carotenoids, energy intake, and mother education. CONCLUSIONS: Weight status and adipose tissue distribution mediate the positive correlation between exclusive breastfeeding duration and skin carotenoids among children aged 7-12 y. The results indicate the need to support breastfeeding and healthy physical growth in childhood for optimal carotenoid status.This trial was registered at clinicaltrials.gov as NCT03521349.

School Lunch Timing and Children's Physical Activity During Recess: An Exploratory Study.

OBJECTIVE: To examine the relationship between school lunch timing (before vs after recess) on physical activity (PA) during recess and energy balance and food intake at lunch. METHODS: A cross-sectional study design was used to examine lunch intake and PA during recess among fourth- and fifth-graders (n = 103) over 5 school days. Lunch and PA were measured using a weighted plate waste technique and accelerometry, respectively. RESULTS: Children who received lunch before recess accumulated lower residual energy (ie, energy intake at lunch minus energy expenditure during recess) and consumed a greater proportion of milk servings. No timing effects were observed for other lunch and PA variables. CONCLUSIONS AND IMPLICATIONS: Lunch intake and activity during recess are related to lunch timing policy. Findings warrant further examination using experimental and quasi-experimental studies to better understand the impact of timing on health behaviors.

Relations between mode of birth delivery and timing of developmental milestones and adiposity in preadolescence: A retrospective study.

BACKGROUND: Cesarean delivery (CS) is an increasingly common mode of delivery comprising over 30% of all deliveries in the U.S. The long-term impact of this delivery mode on child development remains unclear. AIMS: We investigated the relationship between mode of delivery (vaginal vs. CS) and timing of developmental milestones and adiposity in preadolescence, as well as additional milestones beyond motor/language development including toilet training, dressing, and feeding self. STUDY DESIGN: This study utilized a retrospective survey given to a parent/guardian and dual energy x-ray absorptiometry in preadolescence, respectively. A composite z-score was calculated based on nine questions pertaining to developmental milestones i.e., parent-reported age for supporting head by self, rolling over, sitting up, standing, walking, talking, toilet-training, dressing, and feeding self. SUBJECTS: 7-10-year-old (N = 104) children in East-Central Illinois. OUTCOME MEASURES: Composite z-score for timing of attainment of developmental milestones, mode of delivery, and preadolescent adiposity. RESULTS: Vaginally-born children had a lower composite z-score, signifying earlier attainment of developmental milestones, relative to both emergency and planned CS-born children. Further, elective CS-born children had greater adiposity in preadolescence, relative to vaginal and emergency cesarean-section born children. CONCLUSIONS: These findings suggest relationships between delivery mode, developmental milestones, and obesity in preadolescence. Additionally, they provide novel insights into the differential impact of elective versus emergency CS.

Relationship Between Physical Activity, Adiposity, and Attentional Inhibition.

BACKGROUND: Physical inactivity and excess adiposity are thought to be detrimental to physical and cognitive health. However, implications of these interrelated health factors are rarely examined together; consequently, little is known regarding the concomitant contribution of physical activity and adiposity to cognition. METHODS: Bivariate correlations and hierarchical linear regressions were conducted among a sample of adults between 25 and 45 years (N = 65). Attentional inhibition was assessed using an Eriksen Flanker task. Whole-body percent body fat (%Fat) was assessed using dual-energy X-ray absorptiometry. Daily percent time spent in moderate to vigorous physical activity (%MVPA) was monitored using an accelerometer (7 d). RESULTS: After adjusting for significant covariates, %MVPA was a positive predictor of accuracy in the incongruent task (ß = 0.31, P = .03). Individuals who engaged in greater %MVPA exhibited superior attentional inhibition. Additionally, there was an interaction effect of %Fat and %MVPA on attentional inhibition (ß = 0.45, P = .04). CONCLUSION: The positive influence of MVPA on cognitive control persists following the adjustment of significant covariates and adiposity. Additionally, interactive effects between %Fat and %MVPA suggest that individuals with lower activity and greater adiposity exhibited poorer attentional inhibition. These findings have relevance for public health given the elevated rates of physical inactivity and obesity.

The Negative Influence of Adiposity Extends to Intraindividual Variability in Cognitive Control Among Preadolescent Children.

OBJECTIVE: The objective of this study was to investigate the relationship between adiposity and cognition by using mean accuracy, mean reaction time, and intraindividual variability (IIV) among preadolescents. METHODS: Children 7 to 9 years old (N = 233, 133 females) underwent dual-energy x-ray absorptiometry and a maximal oxygen consumption test to assess whole-body adiposity and aerobic fitness relative to fat-free mass (VO2 FF), respectively. Attentional inhibition was assessed by using a modified flanker task. IIV was assessed as standard deviation of reaction time and as a coefficient of variation of reaction time (CVRT). Hierarchical linear regression analyses were performed to examine the relationships between adiposity and cognitive measures following the adjustment of significant demographic factors, intelligence quotient, and VO2 FF. RESULTS: Whole-body adiposity was negatively related to congruent trial mean accuracy and reaction time and to CVRT in both the congruent and incongruent trials. Differences in cognitive function across weight status were selectively evident for measures of IIV, such that children with overweight/obesity (≥ 85th BMI-for-age percentile) exhibited higher CVRT for both the congruent and incongruent trials. CONCLUSIONS: This work provides additional evidence linking childhood obesity to poorer cognitive function and includes novel data extending the negative influence of adiposity to measures of intraindividual response variability in cognitive control, even after accounting for intellectual abilities, aerobic fitness, and demographic factors.

The Role of Retinal Carotenoids and Age on Neuroelectric Indices of Attentional Control among Early to Middle-Aged Adults.

One apparent consequence of aging appears to be loss of some aspects of cognitive control. This loss is measurable as early as mid-adulthood. Since, like many aspects of cognition, there is wide variance among individuals, it is possible that behavior, such as one's diet, could drive some of these differences. For instance, past data on older humans and non-human primates have suggested that dietary carotenoids could slow cognitive decline. In this study, we tested how early such protection might manifest by examining a sample (n = 60) of 25-45 year olds. Carotenoid status was assessed by directly measuring macular pigment optical density (MPOD) which has shown to be highly correlated with the primary carotenoid in brain, lutein. Cognitive control was measured using event-related potentials during the performance of cognitive control tasks designed to tap into different aspects of attentional (i.e., selective attention, attentional inhibition, and response inhibition) control. Our results showed that, across participants, MPOD was related to both age and the P3 component of participants' neuroelectric profile (P3 amplitude) for attentional, but not response, inhibition. Although younger adults exhibited larger P3 amplitudes than their older adult counterparts, older subjects with higher MPOD levels displayed P3 indices similar to their younger adult counterparts in amplitude. Furthermore, hierarchical regression analyses showed that age was no longer a significant predictor of P3 amplitude when MPOD was included as a predictor in the model, suggesting that MPOD may partially contribute to the relationship between age and P3 amplitude. In addition, age and MPOD were shown to have independent associations with intraindividual variability of attentional control, such that younger individuals and individuals with higher MPOD showed less intraindividual variability. These results show a relationship between retinal carotenoids and neuroelectric indices underlying cognitive control. The protective role of carotenoids within the CNS may be evident during early and middle adulthood, decades prior to the onset of older age.