Using Sensory Science to Evaluate Consumer Acceptance of Recipes in a Nutrition Education Intervention for Limited Resource Populations.

OBJECTIVE: This study evaluated consumer acceptance of recipes in a nutrition education intervention and assessed participants' intentions to change dietary behaviors. DESIGN: Study participants tasted and evaluated 16 recipes in the University of Georgia Food Talk curriculum using the 9-point hedonic scale and indicated their likelihood of engaging in behaviors to improve diet quality on a similar, ordinal scale. SETTING AND PARTICIPANTS: Convenience samples of 89 to 122 adult participants in the Expanded Food and Nutrition Education Program in Georgia evaluated each recipe. INTERVENTION: Eight interactive nutrition education sessions in which study participants sampled and evaluated 2 recipes per session. MAIN OUTCOME MEASURES: Mean scores for overall liking of each recipe and likelihood of engaging in promoted behaviors to improve diet quality were outcomes of interest. ANALYSIS: Descriptive statistics were generated. Relationships between overall liking of recipes and intention to engage in promoted behaviors were assessed with Spearman correlation coefficients. RESULTS: Results showed that 13 of the 16 recipes in the curriculum met criteria for acceptable sensory quality. Overall liking was significantly correlated with participants' intentions to engage in behaviors to improve diet quality. Notable age- and sex-related differences were identified. CONCLUSIONS AND IMPLICATIONS: Evaluations of consumer acceptance may be useful in interventions designed to improve diet quality through the introduction of new recipes as improving consumer acceptance of recipes may improve program outcomes.

Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention.

BACKGROUND: Community-based educational programs can complement clinical strategies to increase cancer screenings and encourage healthier lifestyles to reduce cancer burden. However, implementation quality can influence program outcomes and is rarely formally evaluated in community settings. This mixed-methods study aimed to characterize implementation of a community-based cancer prevention program using the Consolidated Framework for Implementation Research (CFIR), determine if implementation was related to participant outcomes, and identify barriers and facilitators to implementation that could be addressed. METHODS: This study utilized quantitative participant evaluation data (n = 115) and quantitative and qualitative data from semi-structured interviews with program instructors (N = 13). At the participant level, demographic data (age, sex, insurance status) and behavior change intention were captured. Instructor data included implementation of program components and program attendance to create a 7-point implementation score of fidelity and reach variables. Degree of program implementation (high and low) was operationalized based on these variables (low: 0-4, high: 5-7). Relationships among degree of implementation, participant demographics, and participant outcomes (e.g., intent to be physically active or limit alcohol) were assessed using linear or ordinal logistic mixed effects models as appropriate. Interview data were transcribed and coded deductively for CFIR constructs, and constructs were then rated for magnitude and valence. Patterns between ratings of high and low implementation programs were used to determine constructs that manifested as barriers or facilitators. RESULTS: Program implementation varied with scores ranging from 4 to 7. High implementation was related to greater improvements in intention to be physically active (p <  0.05), achieve a healthy weight (p <  0.05), and limit alcohol (p <  0.01). Eight constructs distinguished between high and low implementation programs. Design quality and packaging, compatibility, external change agents, access to knowledge and information, and experience were facilitators of implementation and formally appointed internal implementation leaders was a barrier to implementation. CONCLUSIONS: As higher implementation was related to improved participant outcomes, program administrators should emphasize the importance of fidelity in training for program instructors. The CFIR can be used to identify barriers and/or facilitators to implementation in community interventions, but results may be unique from clinical contexts.

An Evaluation of Inter-coder and Intra-coder Reliability for 24-Hour Dietary Recall Data Entered in WebNEERS.

OBJECTIVE: To evaluate inter-coder (between-coder) and intra-coder (within-coder) reliability among trained data coders who enter 24-hour dietary recall data collected through Expanded Food and Nutrition Education Program operations in the state of Georgia. DESIGN: This study employed multiple cross-sectional evaluations of inter-coder reliability and a short-term longitudinal evaluation of intra-coder reliability. PARTICIPANTS/SETTING: Study participants consisted of trained data coders (n = 9) who were employed during the 12-month period of evaluation. MAIN OUTCOME MEASURES: Primary outcome measures were inter-coder and intra-coder reliability across data entered into the Web-based Nutrition Education Evaluation and Reporting System. Statistical analyses were conducted using IBM SPSS 24. Descriptive statistics were generated and inter-coder and intra-coder reliability were assessed using 2-way mixed intraclass correlation coefficients. RESULTS: Results of this evaluation indicated good to excellent inter-coder reliability among all coders, and excellent intra-coder reliability among the majority of coders. However, some notable inconsistencies were identified within the intra-coder reliability analyses. CONCLUSIONS: Future strategies to improve data quality within Expanded Food and Nutrition Education Program operations might include enhanced training for data coders, implementation of error detection protocols, expansion of the Web-based Nutrition Education Evaluation and Reporting System database, and exploration of automated, computer-assisted administration of 24-hour dietary recalls.

Understanding the control of ingestive behavior in primates.

This article is part of a Special Issue "Energy Balance". Ingestive behavior in free-ranging populations of nonhuman primates is influenced by resource availability and social group organization and provides valuable insight on the evolution of ecologically adaptive behaviors and physiological systems. As captive populations were established, questions regarding proximate mechanisms that regulate food intake in these animals could be more easily addressed. The availability of these captive populations has led to the use of selected species to understand appetite control or metabolic physiology in humans. Recognizing the difficulty of quantitating food intake in free-ranging groups, the use of captive, singly-housed animals provided a distinct advantage though, at the same time, produced a different social ecology from the animals' natural habitat. However, the recent application of novel technologies to quantitate caloric intake and energy expenditure in free-feeding, socially housed monkeys permits prospective studies that can accurately define how food intake changes in response to any number of interventions in the context of a social environment. This review provides an overview of studies examining food intake using captive nonhuman primates organized into three areas: a) neurochemical regulation of food intake in nonhuman primates; b) whether exposure to specific diets during key developmental periods programs differences in diet preferences or changes the expression of feeding related neuropeptides; and c) how psychosocial factors influence appetite regulation. Because feeding patterns are driven by more than just satiety and orexigenic signals, appreciating how the social context influences pattern of feeding in nonhuman primates may be quite informative for understanding the biological complexity of feeding in humans.

Dietary variety is associated with larger meals in female rhesus monkeys.

The complex, interacting influences on eating behavior and energy expenditure prevent elucidation of the causal role of any single factor in the current obesity epidemic. However, greater variety in the food supply, particularly in the form of highly palatable, energy-dense foods, has likely made a contribution. This study was undertaken to test the hypothesis that greater dietary variety is associated with greater caloric intake within individual meals consumed by free-feeding, socially-housed female rhesus monkeys. Meal patterns were assessed during two, two-week dietary phases. One phase consisted of a choice between a standard chow diet and a highly palatable diet (HPD). The other phase consisted of access to the chow only. Food intake for each subject was recorded continuously using previously validated, automated feeders, and a meal was defined based on a minimum kilocalorie requirement and a minimum inter-meal interval. During the choice condition, animals electively consumed mixed meals that incorporated both diets as well as other meals that consisted exclusively of a single diet - chow-only or HPD-only. Animals consumed the most calories per meal when the meal was comprised of both the chow and HPD, which differed in caloric density, flavor, and texture. Interestingly, however, there was no significant difference in the amount of calories consumed as HPD-only meals in the choice condition compared to meals in the chow-only, no choice condition, suggesting consumption of a single food during a meal, regardless of palatability, provides a constant sensory experience that may lead to more rapid habituation and subsequent meal cessation. Additionally, during the dietary choice condition, animals consumed fewer calories in the form of chow-only meals. Thus, the present results suggest that limiting dietary variety, regardless of palatability, may be a useful strategy for weight loss in overweight and obese individuals by reducing caloric intake within individual meals.

Small changes in meal patterns lead to significant changes in total caloric intake. Effects of diet and social status on food intake in female rhesus monkeys.

Social subordination in macaques is a well-established model to study the adverse effects of psychosocial stress on a number of health outcomes, including stress-induced eating. The present analysis was conducted to empirically define a meal among free-feeding female rhesus monkeys and to examine the roles of meal patterning (e.g., meal size, meal frequency, and snacking patterns) in findings from a previous study demonstrating that psychosocial stress increases overall caloric intake among subordinate animals with access to a highly palatable diet. Results indicate that all animals, regardless of social status, consumed more frequent meals, larger meals, and more calories in the form of snacks when a highly palatable diet was available. Additional findings suggest that subordinate animals consumed significantly larger meals compared to their dominant counterparts regardless of the dietary environment. Additionally, subordinate females with a history of exposure to the palatable diet consumed significantly more snack calories than both dominant and subordinate animals without previous exposure to the palatable diet when these females were returned to a standard laboratory diet. These findings illustrate how small changes in meal patterns can lead to significant increases in total caloric intake, which if prolonged, could promote the emergence of an obese phenotype.

Social position, psychological stress, and obesity: a systematic review.

This review presents a conceptual framework for understanding the relationship between social position and obesity, focusing on stress as a contributing factor. Through a systematic review of the literature, the studies that assess associations between social position, stress levels, dietary behaviors, and obesity risk in human beings were identified. Fourteen studies were retained based upon a priori inclusion/exclusion criteria. Across studies, individuals in higher status positions tended to have lower stress levels, healthier eating patterns, and lower body weight. Higher stress was associated with less healthy dietary behaviors and with higher body weight. These patterns were more pronounced in women than in men. The nature of the stress-eating-obesity relationship is complicated, and this literature must be developed further, because its advancement may be instrumental in identifying successful stress management techniques that can be used by food and nutrition practitioners to improve nutrition-related outcomes.