Perceived environmental supports for fruit and vegetable consumption among older adults in the US.

BACKGROUND: The physical and social environments surrounding food, whether perceived or observed, can influence consumers' food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur. AIM: To describe older adults' perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults' recommendations for communities to facilitate fruit and vegetable consumption. METHODS: Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption. RESULTS: The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables. CONCLUSION: Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers' perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.

Questionnaire on Irritable Bowel Syndrome and Symptom Management Among Endurance Athletes Is Valid and Reliable.

BACKGROUND: Gastrointestinal symptoms are reported in a large proportion of endurance athletes, with similarities in symptom type and distribution to irritable bowel syndrome (IBS). AIMS: The objective of this study was to develop and validate a questionnaire to assess IBS diagnoses or fit to IBS diagnostic criteria in this population along with nutritional habits, gastrointestinal symptoms, and symptom management strategies. METHODS: A 93-item Endurance Athlete Questionnaire was developed to address the objective, targeted at American endurance athletes completing a marathon, ultra-marathon, half-distance triathlon, and/or full-distance triathlon that year. Content validity was established by expert reviewers (n = 6), and face validity was evaluated by endurance athletes (n = 9). Test-retest reliability was assessed by target athletes (n = 51). Participants completed two rounds of the questionnaire, separated by 1-2 weeks. Results were analyzed using Pearson and Spearman correlations and paired comparisons. RESULTS: Slight modifications in wording and three demographic questions were added based on the input of expert and athlete reviews. Pearson correlation coefficient of test-retest total questionnaire scores was significant at 0.839 (P < 0.001). Paired comparison of individual questions found significant differences in 10 of 236 analyzed responses; however, these did not affect fit to IBS diagnostic criteria for those without other GI diseases/disorders. CONCLUSIONS: The Endurance Athlete Questionnaire proved to be a valid and reliable measure of IBS diagnostic criteria, gastrointestinal symptoms, nutritional habits, and symptom management strategies among endurance athletes. Future implementation will help inform gastroenterologists with endurance athlete patients and can elucidate whether certain behaviors could be contributing to athlete gastrointestinal symptoms.

Mobile Apps for the Dietary Approaches to Stop Hypertension (DASH): App Quality Evaluation.

OBJECTIVE: To identify the availability and quality of apps supporting Dietary Approaches to Stop Hypertension (DASH) education. METHODS: The researchers identified DASH apps over 1 month in the Apple App Store. Five registered dietitians used the App Quality Evaluation (AQEL) to evaluate app quality on 7 domains. Interrater reliability was tested using intraclass correlations. RESULTS: One paid and 3 free DASH apps were evaluated. Interrater reliability (n = 5) was good for 3 apps and fair for 1 app. Only the paid app scored high (>8 of 10) on most AQEL quality domains. CONCLUSIONS AND IMPLICATIONS: Based on lower quality found among the included free apps, further development of free apps is warranted. Whereas the paid app may be useful in supporting DASH education, future research should determine whether improvements in clinical outcomes are found and whether this app should be improved to address AQEL domains better.

A New Tool for Nutrition App Quality Evaluation (AQEL): Development, Validation, and Reliability Testing.

BACKGROUND: The extensive availability and increasing use of mobile apps for nutrition-based health interventions makes evaluation of the quality of these apps crucial for integration of apps into nutritional counseling. OBJECTIVE: The goal of this research was the development, validation, and reliability testing of the app quality evaluation (AQEL) tool, an instrument for evaluating apps' educational quality and technical functionality. METHODS: Items for evaluating app quality were adapted from website evaluations, with additional items added to evaluate the specific characteristics of apps, resulting in 79 initial items. Expert panels of nutrition and technology professionals and app users reviewed items for face and content validation. After recommended revisions, nutrition experts completed a second AQEL review to ensure clarity. On the basis of 150 sets of responses using the revised AQEL, principal component analysis was completed, reducing AQEL into 5 factors that underwent reliability testing, including internal consistency, split-half reliability, test-retest reliability, and interrater reliability (IRR). Two additional modifiable constructs for evaluating apps based on the age and needs of the target audience as selected by the evaluator were also tested for construct reliability. IRR testing using intraclass correlations (ICC) with all 7 constructs was conducted, with 15 dietitians evaluating one app. RESULTS: Development and validation resulted in the 51-item AQEL. These were reduced to 25 items in 5 factors after principal component analysis, plus 9 modifiable items in two constructs that were not included in principal component analysis. Internal consistency and split-half reliability of the following constructs derived from principal components analysis was good (Cronbach alpha >.80, Spearman-Brown coefficient >.80): behavior change potential, support of knowledge acquisition, app function, and skill development. App purpose split half-reliability was .65. Test-retest reliability showed no significant change over time (P>.05) for all but skill development (P=.001). Construct reliability was good for items assessing age appropriateness of apps for children, teens, and a general audience. In addition, construct reliability was acceptable for assessing app appropriateness for various target audiences (Cronbach alpha >.70). For the 5 main factors, ICC (1,k) was >.80, with a P value of <.05. When 15 nutrition professionals evaluated one app, ICC (2,15) was .98, with a P value of <.001 for all 7 constructs when the modifiable items were specified for adults seeking weight loss support. CONCLUSIONS: Our preliminary effort shows that AQEL is a valid, reliable instrument for evaluating nutrition apps' qualities for clinical interventions by nutrition clinicians, educators, and researchers. Further efforts in validating AQEL in various contexts are needed.

Influence of seasoning on vegetable selection, liking and intent to purchase.

Low vegetable intake continues to be a health concern, and strategies to increase vegetable intake have resulted in only small increases. One strategy that has received less attention is the use of seasonings. This study's objective was to determine the impact of seasoning on vegetable selection, liking, and intent to purchase. We conducted a 3-week study in a public café on a university campus. Customers buying a main dish could select a vegetable side (seasoned [SS] or steamed [ST]) at no cost. Based on café data and power analysis (alpha 0.05, 80% power), 2 days per vegetable pair were conducted with carrot, broccoli, and green bean pairs randomized 3 days/week 1 and 3, with normal service week 2. Selection was greater for SS vs ST, n = 335 vs. 143 for all 3 vegetables combined; n = 97 vs 47 for carrots; n = 114 vs. 55 for broccoli; n = 124 vs. 41 for green beans (p < 0.001 Chi-Square). Liking responses were similar for SS vs ST and were high for all vegetables. Response distribution was not significantly different for SS vs ST vegetables when people were asked if they would purchase the vegetable that they selected. More customers chose the 'somewhat likely' and 'very likely' (n = 353) than the 'not likely' and 'definitely would not' (n = 121) purchase responses. Regression showed that people who did not often consume a vegetable with lunch while dining out were 1.59 times more likely to select the SS vegetables over the ST (p = 0.007). Given a choice, consumers were more likely to select a seasoned vegetable. With low vegetable consumption as a predictor of seasoned vegetable choice, offering seasoned vegetables may increase intake in those with poor vegetable intake in a café setting.

Spice and Herb Use with Vegetables: Liking, Frequency, and Self-efficacy among US Adults.

OBJECTIVES: To inform future initiatives to encourage vegetable intake, we explored how spice and herb (S/H) use with vegetables was related to consumer characteristics. METHODS: A questionnaire collected information on S/H liking and use frequency, whether S/Hs were used when cooking vegetables, and belief that consumers could use S/Hs when cooking vegetables. The questionnaire was distributed to members of an online panel of US consumers. RESULTS: Younger respondents (18-29 years) and respondents who identified as Asian/ Pacific Islander or other racial group used 19 of the 20 S/Hs more frequently than their older and white/Caucasian, African-American or Hispanic counterparts, respectively. S/H use when cooking vegetables at home was significantly higher for women. Self-efficacy was higher for women, 18-29 year-olds, and 30-49 year-olds, and lower for respondents who identified as white/Caucasian race and those with annual incomes below 50,000. CONCLUSIONS: Low-income, male, older ( 50 years), and white/ Caucasian respondents were identified as target audiences that may benefit the most from interventions encouraging S/H use with vegetables to increase consumption. It is critical to account for socio-demographic characteristics of the audience when designing interventions.

The use of mobile apps to improve nutrition outcomes: A systematic literature review.

We conducted a systematic review to determine if the use of nutrition apps resulted in improved outcomes, including knowledge and behavior, among healthy adults. Using app(s), cellular phone, iPads, mobile phone, mobile telephone, smart phone, mobile and mHealth as search terms with diet, food and nutrition as qualifiers we searched PubMed, CINAHL (January 2008-October 2013) and Web of Science (January 2008-January 2014). Inclusion criteria were peer-reviewed randomized controlled trials, non-controlled trials, and cohort studies published in English that used apps to increase nutrition knowledge or improve behavior related to nutrition. Studies that were descriptive, did not include apps, focused on app development, app satisfaction app feasibility, text messaging, or digital photography were excluded. We evaluated article quality using the Academy of Nutrition and Dietetics Evidence Analysis Manual. Data was extracted for knowledge, behavior and weight change. Our initial search identified 12,010 titles from PubMed, 260 from CINAHL and 4762 from Web of Science; of these, only four articles met all search criteria. Positive quality ratings were given to three articles; only one reported knowledge outcomes (non-significant). All four articles evaluated weight loss and suggested an advantage to using nutrition apps. Behavioral changes in reviewed studies included increased adherence to diet monitoring (p < 0.001) and decreased effort to continue diet without app (p = 0.024). Few studies, however, have explored the use of nutrition apps as supportive educational interventions. Most apps focus on weight loss with inconsistent outcomes. We conclude that using apps for education needs additional research which includes behavior theory within the app and improved study design.

Nutritional status as assessed by nutrient intakes and biomarkers among women of childbearing age--is the burden of nutrient inadequacies growing in America?

OBJECTIVE: Understanding nutrient intakes among women of childbearing age within the USA is important given the accumulating evidence that maternal body weight gain and nutrient intakes prior to pregnancy may influence the health and well-being of the offspring. The objective of the present study was to evaluate nutritional status in women of childbearing age and to ascertain the influence of ethnicity and income on nutrient intakes. DESIGN: Nutritional status was assessed using data on nutrient intakes through foods and supplements from the National Health and Nutrition Examination Survey. Biomarker data from the Centers for Disease Control and Prevention were used to assess nutritional status for selected nutrients. Poverty-income ratio was used to assess family income. SUBJECTS: White (n 1560), African-American (n 889) and Mexican-American (n 761) women aged 19-30 and 31-50 years were included. SETTING: A nationally representative sample of non-pregnant women of childbearing age resident in the USA. RESULTS: African-American women had the lowest intakes of fibre, folate, riboflavin, P, K, Ca and Mg. Women (31-50 years) with a poverty-income ratio of ≤ 1.85 had significantly lower intakes of almost all nutrients analysed. Irrespective of ethnicity and income, a significant percentage of women were not consuming the estimated recommended amounts (Estimated Average Requirement) of several key nutrients: vitamin A (~80%), vitamin D (~78%) and fibre (~92%). Nutrient biomarker data were generally reflective of nutrient intake patterns among the different ethnic groups. CONCLUSIONS: Women of childbearing age in the USA are not meeting nutrient intake guidelines, with differences between ethnic groups and socio-economic strata. These factors should be considered when establishing nutrition science advocacy and policy.

Impact of computer-mediated, obesity-related nutrition education interventions for adolescents: a systematic review.

PURPOSE: The purpose of this systematic review was to evaluate recent research regarding the use of computer-based nutrition education interventions targeting adolescent overweight and obesity. METHODS: Online databases were systematically searched using key words, and bibliographies of related articles were manually searched. Inclusion/exclusion criteria were applied and included studies evaluated for their ability to achieve their objectives and for quality using the Nutrition Evidence Library appraisal guidelines for research design and implementation. RESULTS: Of the 15 studies included, 10 were randomized controlled trials. Two studies targeted weight loss, 2 targeted weight maintenance, and 11 targeted dietary improvement with or without physical activity. At least half of in-school (60%) and nonschool interventions (80%) exhibited significantly positive effects on nutrition- or obesity-related variables. Small changes in diet, physical activity, knowledge, and self-efficacy were shown; however, few results were sustained long term. CONCLUSIONS: Recommendations included application of health behavior theory and computer tailoring for feedback messages. Future research should include thorough description of intervention content (messages, theory, multimedia, etc.), application of rigorous methodology, as well as consideration of covariates such as parental involvement and gender. With further research and evidentiary support, this approach to obesity-related nutrition education has the potential to be successful.

Ethnic variation in risk for osteoporosis among women: a review of biological and behavioral factors.

Most studies of risk factors for osteoporosis and nontraumatic fracture involve white women, although more research is being geared toward bone health among various ethnic groups. The purpose of this review is to provide an overview of health disparity in osteoporosis, including assessment of bone mineral density (BMD), bone health screening, lifestyle risk factors, and treatment involving white, black, Hispanic, Asian, and Native American women. This review summarizes evidence that white, Asian, Hispanic, and Native American women are more at risk for osteoporosis than black women. These conclusions are supported by the disparity in BMD between white and black women, although the reason for this biological difference is not well characterized. Additional research is needed to determine if there is a significant difference in BMD among Hispanic, Asian, and Native American women independent of body weight and size. Similarly, there is also disparity in fracture rates, with the causes presumed to be multifactorial. Calcium intake is lower than recommended in all females at all ages; however, it is much lower in black and Native American women and highest in white and Hispanic women. Black women also have a lower vitamin D status than white women, with mean vitamin D status of Hispanic American women lying between that of black and white women. Similarly, although white women are more active than black and Hispanic women at all ages, data are lacking about physical activity habits of women of other ethnic backgrounds and how this impacts bone health. Finally, screening protocols for women of various ethnicities and effectiveness of treatments are not well established and remain a priority in women's health.

Older black women differ in calcium intake source compared to age- and socioeconomic status-matched white women.

Racial disparity in osteoporosis between older black and white women is well established; however, less is known regarding daily dietary and supplemental calcium intake in these populations. Moreover, racial differences in calcium intake are confounded by differences in socioeconomic status (SES). The objective of this study was to assess calcium intake and source in older black women (n=33) and white women (n=33), matched in age and SES. Calcium intake and source were evaluated by interview using a 46-item calcium food frequency questionnaire including all food groups and supplements. Black and white women were identical in SES and matched on age (black women 66.9+/-6.2 years vs white women 67.1+/-5.5 years [mean+/-standard deviation], P=0.85). No significant difference existed for dietary calcium intake between black and white women (974+/-524 vs 1,070+/-600 mg/day; P=0.65) or total calcium intake between black and white women (1,485+/-979 vs 1,791+/-887 mg/day; P=0.15). Dairy foods contributed most to dietary calcium intake in black and white women and differed by race (black women 402+/-269 mg/day, white women, 603+/-376 mg/day; P=0.02). Calcium intake from grains differed by race (black women 205+/-201 mg/day vs white women 130+/-234 mg/day; P=0.010) and fortified cereals were a major source of calcium for black women. Calcium supplementation contributed substantially to total calcium intake in both groups, with more white women (n=23, 70%) using supplements than black women did (n=19, 58%). However, no racial difference existed in supplemented calcium intake (black women, n=19; 889+/-605 vs white women, n=23; 1,034+/-460 mg/day; P=0.20). Our data suggest that total daily dietary and supplemental calcium intakes do not differ, but calcium intake from dairy foods and from grains differ in older black and white women matched in age and SES.

Poor intake of milk, vegetables, and fruit with limited dietary variety by Botswana's elderly.

The aim of this research was to determine dietary intake of elderly Batswana, evaluate the diet quality using the Health Eating Index (HEI), identify factors associated with poor quality, and determine the impact of age on dietary scores. Villages and towns were selected in three strata: urban, semi-urban, and rural. A total of 99 elderly (67% female, 33% males), age range 60-95 years, were recruited through purposive sampling. A 24-hour multiplepass food recall was combined with demographic, health, and cooking responsibilities questions. The elderly diet met requirements for only the Grains group (9 serving/day). Most elderly obtained good HEI component scores on fat, saturated fat, cholesterol, sodium, and Grains group intake. The HEI scores were poor for variety, milk, fruits, and vegetables. Most elderly had poor diet (38%) or a diet that needed improvement (59%), and only 3% had a good diet.

Applying the theory of planned behavior to women's behavioral attitudes on and consumption of soy products.

OBJECTIVE: To identify variables that significantly predict the intention and behavior concerning soy consumption applying the Theory of Planned Behavior and to determine the role of race on women's perspectives and consumption behaviors concerning soy. DESIGN: Cross-sectional survey, with self-administered questionnaires. SETTING: City park service programs, community organizations, black cultural classes, and university offices. PARTICIPANTS: A convenience sample of 205 black (n = 103) and white (n = 102) women. VARIABLES MEASURED: Women's behavioral attitudes, subjective norms, perceived behavioral control, intention, and behavior related to soy consumption. ANALYSIS: Correlation and stepwise regression analysis. RESULTS: All variables in the Theory of Planned Behavior showed significant correlations with behavioral intention, with behavioral attitudes exhibiting the strongest correlation (r = .57, P < .01). Stepwise multiple regression analyses revealed that behavioral attitude toward taste and subjective norms accounted for 47.7% of the variance in behavioral intention. Behavioral attitude toward taste explained 48.6% of the variability in behavior. There was no difference between races for consumption or Theory of Planned Behavior variables. CONCLUSIONS AND IMPLICATIONS: A negative attitude toward the taste of soy was the major predictor for low soy consumption. However, future studies should be undertaken to verify this relationship once more women become aware of and have tasted soy.