Evaluation of the Effectiveness of a Bilingual Nutrition Education Program in Partnership with a Mobile Health Unit.

There are limited reports of community-based nutrition education with culinary instruction that measure biomarkers, particularly in low-income and underrepresented minority populations. Teaching kitchens have been proposed as a strategy to address social determinants of health, combining nutrition education, culinary demonstration, and skill building. The purpose of this paper is to report on the development, implementation, and evaluation of Journey to Health, a program designed for community implementation using the RE-AIM planning and evaluation framework. Reach and effectiveness were the primary outcomes. Regarding reach, 507 individuals registered for the program, 310 participants attended at least one nutrition class, 110 participants completed at least two biometric screens, and 96 participants attended at least two health coaching appointments. Participants who engaged in Journey to Health realized significant improvements in body mass index, blood pressure, and triglycerides. For higher risk participants, we additionally saw significant improvements in total and LDL cholesterol. Regarding dietary intake, we observed a significant increase in cups of fruit and a decrease in sugar sweetened beverages consumed per day. Our findings suggest that Journey to Health may improve selected biometrics and health behaviors in low-income and underrepresented minority participants.

A Retrospective Chart Review Suggests That Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration.

Purpose: The objective of this study was to conduct a secondary data analysis of clinical information documented in the electronic medical record to assess the clinical outcomes of patients who received three different treatment approaches on clinical outcomes for treatment of patients with anorexia nervosa (AN). Patients and methods: Historical electronic medical record (EMR) data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes [body mass index for adults (BMI), body mass index percentile (BMI%ile) for pediatric patients] defined AN severity and weight restoration. EMR data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively. Results: Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). In addition, patients receiving care from 1 to 2 providers (OR = 1.006, 95% CI [1.003, 1.010], p = 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011], p = 0.021) had significantly higher odds of weight restoration per provider visit day compared with patients receiving hospital-based services only. Conclusion: This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting.

Microbial taxonomic and functional shifts in adolescents with type 1 diabetes are associated with clinical and dietary factors.

BACKGROUND: Evidence indicates a link between the pathogenesis of type 1 diabetes (T1D) and the gut microbiome. However, the regulation of microbial metabolic pathways and the associations of bacterial species with dietary factors in T1D are largely unknown. We investigated whether microbial metagenomic signatures in adolescents with T1D are associated with clinical/dietary factors. METHODS: Adolescents with T1D (case) and healthy adolescents (control) were recruited, and microbiome profiling in participants' stool samples was performed using shotgun metagenomic sequencing. The bioBakery3 pipeline (Kneaddata, Metaphlan 4 and HUMAnN) was used to assign taxonomy and functional annotations. Clinical (HbA1c) and dietary information (3-day food record) were collected for conducting association analysis using Spearman's correlation. FINDINGS: Adolescents with T1D exhibited modest changes in taxonomic composition of gut microbiome. Nineteen microbial metabolic pathways were altered in T1D, including downregulation of biosynthesis of vitamins (B2/flavin, B7/biotin and B9/folate), enzyme cofactors (NAD+ and s-adenosyl methionine) and amino acids (aspartate, asparagine and lysine) with an upregulation in the fermentation pathways. Furthermore, bacterial species associated with dietary and clinical factors differed between healthy adolescents and adolescents with T1D. Supervised models modeling identified taxa predictive of T1D status, and the top features included Coprococcus and Streptococcus. INTERPRETATION: Our study provides new insight into the alteration of microbial and metabolic signatures in adolescents with T1D, suggesting that microbial biosynthesis of vitamins, enzyme cofactors and amino acids may be potentially altered in T1D. FUNDING: Research grants from NIH/NCCIH: R01AT010247 and USDA/NIFA: 2019-67017-29253; and Larry & Gail Miller Family Foundation Assistantship.

Development and Validation of a Diabetes Questionnaire for Middle School Students.

OBJECTIVE: To develop and validate a questionnaire to assess diabetes knowledge, attitudes, beliefs, and intent to change among middle school students. DESIGN: A cross-sectional validation analysis. SETTING: Students in 3 urban middle schools in Utah participated in this study. PARTICIPANTS: The 25-item questionnaire was validated in independent samples of 277 and 304 students in the seventh and eighth grades. VARIABLES MEASURED: The questionnaire includes the following variables: diabetes knowledge, attitudes, beliefs, and intent to change dietary and physical activity behaviors. ANALYSIS: Rigorous statistical approaches, including Cronbach's α (goodness of fit) calculation, test-retest reliability, and exploratory and confirmatory factor analyses, were employed to examine the reliability and construct validity. RESULTS: The Cronbach's α coefficients were 0.7 for both subscales demonstrating acceptable internal consistency. All factor loadings were > 0.4, revealing close relations between factors and items. The confirmatory factor analysis model fit was 0.9 for the comparative fit index and Tucker-Lewis Index, indicating a reasonable model-data fit. CONCLUSIONS AND IMPLICATIONS: This study demonstrated the validity of a diabetes questionnaire for middle school students. Future work is needed to validate its use in a diabetes prevention program, given the growing need for diabetes education among young adolescents.

Comprehensive School Physical Activity Programming and Health Behavior Knowledge.

No study to date has examined the effect of a multicomponent school-based physical activity program on health behavior knowledge in a large sample of low-income children from the US. The purpose of this study was to explore the change in physical activity and nutrition knowledge during a Comprehensive School Physical Activity Program (CSPAP) in children. Participants were a convenience sample of 789 children recruited from the 4th to 6th grades from five low-income Title I schools located within the Mountain West Region of the US. Students completed two questionnaires consisting of a physical activity and a nutrition knowledge assessment. Questionnaires were administered at baseline before the commencement of CSPAP and at a 36-week follow-up. Data were analyzed using a 3 × 2 × 2 doubly MANOVA test. Physical activity knowledge scores significantly improved from pretest to posttest during the intervention (p = 0.045, Cohen's d = 0.18). Grade level modified the time effects, with older children in grades 5 and 6 displaying greater improvements in physical activity knowledge than younger children in grade 4 (p = 0.044, Cohen's d = 0.33). There were no significant improvements in nutrition knowledge scores during the CSPAP (p = 0.150). These findings demonstrate that improvements in physical activity knowledge can occur during a multicomponent school-based intervention. Improvements in physical activity knowledge may translate to improvements in habitual physical activity behaviors and positively influence children's health outcomes, especially in older children.

An Interpretive Description of Women's Experience in Coordinated, Multidisciplinary Treatment for an Eating Disorder.

Coordinated, multidisciplinary treatment for women with eating disorders is consistently recommended as maximally effective, but few studies have considered the patient experience. This qualitative study examined the experiences of women receiving such care in an outpatient setting. Using an interpretive description methodology, we conducted 12 in-depth interviews with participants who were diagnosed with an eating disorder and were receiving team-based treatment. Patients uniformly advocated for the coordinated, multidisciplinary treatment approach. Analysis of participants' experiences yielded four categories: relying on the lifeline of communication, supporting autonomy, drawing on individual strengths, and valuing synergy. These findings build on previous research emphasizing the importance of autonomy support and connectedness in the recovery process from an eating disorder. Findings highlight the importance of nurses to support a multidisciplinary care approach to working with this patient population; these women's voices also support a treatment approach that, despite being widely recommended, is vastly understudied and underutilized.

Teachers' Perceived and Desired Roles in Nutrition Education.

BACKGROUND: Elementary teachers have the potential to influence children's eating habits. This study examined teacher views and practices regarding nutrition education. METHODS: An online survey was administered to K-6 teachers (N = 628) in 55 public elementary schools in a large city in the western United States. Three indices were created based on responses. Indices included: (1) attitudes and beliefs about nutrition education; (2) self-efficacy regarding nutrition education; and (3) personal health behaviors. Relationships between indices, classroom practices, and teacher characteristics were tested. Teacher comments were categorized into themes. RESULTS: Most teachers agreed they can make a difference in the eating behaviors of their students (68%). Correlations between hours of nutrition taught and teachers' attitudes and beliefs (r = .37, p < .01), nutrition self-efficacy (r = .38, p < .01), and personal health practices (r = .15, p < .01) were weak, yet statistically significant. Number of years teaching was inversely related to frequency of food rewards (r = -119, p < .01). Few teachers (21%) agreed they have support to teach nutrition in the classroom. CONCLUSION: Teachers understand the importance of nutrition education but provision is limited by competing demands. Teachers suggest tailored nutrition materials, qualified nutrition personnel, and school stakeholder support to promote nutrition education.

Breast-feeding, Leptin:Adiponectin Ratio, and Metabolic Dysfunction in Adolescents with Obesity.

OBJECTIVES: Increased adiposity increases leptin and decreases adiponectin concentrations, resulting in an increased leptin:adiponectin ratio (LAR). In adults, components of the metabolic syndrome and other cardiometabolic risk factors, what we classify here as "metabolic dysfunction," are associated with both a high LAR and a history of being breast-fed. The relation among breast-feeding, LAR, and degree of metabolic dysfunction in obese youth is unknown. The purpose of our pilot study was to explore this relation and estimate the effect size of the relations to determine the sample size needed to power future prospective studies. METHODS: We obtained fasting levels of leptin, adiponectin, lipids, insulin, and glucose from obese youth (aged 8-17 years). Weight, height, waist circumference, blood pressure, and breast-feeding history also were assessed. RESULTS: Of 96 participants, 78 were breast-fed as infants, 54% of whom were breast-fed for >6 months. Wide variation was observed in LARs among children who were and were not breast-fed (>100% coefficient of variation). Overall, prevalence of metabolic dysfunction in the cohort was 94% and was not proven to be associated with higher LAR. CONCLUSIONS: In this cohort of obese youth, we found a high prevalence of breast-feeding, metabolic dysfunction, and wide variation in the LARs. Based on the effect size estimated, future studies would need to enroll >1500 patients or identify, stratify, and selectively enroll obese patients without metabolic dysfunction to accurately determine whether breast-feeding in infancy influences LARs or metabolic dysfunction among obese youth.

A multivariate analysis of federally mandated school wellness policies on adolescent obesity.

PURPOSE: To evaluate the effects of school wellness policies mandated by the 2004 Child Nutrition and WIC Reauthorization Act on the prevalence of overweight and obesity among adolescents. METHODS: Multivariate logistic regressions, adjusted for clustering within school districts, were used to estimate the effects of district-level wellness policies on the odds of overweight and obesity among adolescents. The analyses were performed on a population-based sample obtained from the Utah Population Database, a compilation of vital characteristic, administrative, and genealogical records on all residents in Utah. Models controlled for individual, maternal, and familial characteristics, as well as characteristics of school district of residence. Self-reported body mass index was taken from drivers license data. RESULTS: Each additional component included in a district's wellness policy was associated with as much as: 3.2% lower odds in the prevalence of adolescent overweight (OR = .968; 95% CI = .941-.997), 2.5% lower odds of obesity (OR = .975; CI = .952-.997), and 3.4% lower odds of severe obesity (OR = .966; CI = .938-.995). Wellness policy components related to diet were significantly associated with lower body mass indexes across all three thresholds, whereas those related to physical activity had significant associations for lower odds of severe obesity only. CONCLUSION: Results suggest that school wellness policies can significantly reduce the risk of adolescent obesity. Further research should address specific policy components that are most effective in various populations, as well as the level of commitment that is required at both the school- and district-levels for sustained effect.