Self-Care Instruments to Measure Nutrition Practices in Children and Parents: Psychometric Analysis.

The purposes of this study were to evaluate the psychometric properties of English and Spanish instruments that measure the nutrition behavior and practices of children and their parents. Orem's self-care deficit nursing theory was used in this methodological study. A convenience sample of 333 children and 262 mothers participated from two schools in Washington, D.C. and two schools in Santiago, Chile. Principal component analysis indicated three component per instrument corresponding to Orem's Theory of operations demonstrating construct validity of the instrument. The study findings showed evidence for validity and reliability of the English and Spanish versions and indicated that the instruments appropriately represented Orem's operations. The results have implications for the development of health behavior measurement instruments that are valid, reliable, designed for children, culturally appropriate, and efficient. Measuring the nutrition behavior of children and parents is critical for determining the effectiveness of nutrition intervention programs. Furthermore, instruments are needed so that researchers can compare corresponding child and parent behaviors or compare behaviors across cultures.

COVID-19 and Morbid Obesity: Associations and Consequences for Policy and Practice.

While the impact of obesity on chronic disease has been widely examined, there has been less research regarding the influence of obesity on infectious diseases, particularly respiratory diseases. This exploratory research uses the currently available data on COVID-19 cases and mortality, along with estimates of the morbidly obese populations in the United States by county, to examine the association between morbid obesity and deaths from COVID-19 and to identify potential coincident spatial clusters of morbid obesity and COVID-19 deaths. Results indicate a statistically significant positive correlation between population-adjusted COVID-19 deaths and cases and the estimated population with a body mass index ≥ 40. Clustering analyses show there is a predominant similarity in the distribution of COVID-19 deaths and obesity. Our findings suggest it is critical to include an awareness of obesity when developing infectious disease control measures and point to a greater need to focus resources toward obesity education and policy initiatives.

Survey of health status, nutrition and geography of food selection of chronic liver disease patients.

BACKGROUND: Obesity, a complex disease determined both by genetic and environmental factors, is strongly associated with NAFLD, and has been demonstrated to have a negative impact on HCV and other chronic liver diseases (CLD). RATIONALE: This study assessed the association between type and location of food sources and chronic liver disease (CLD) using Geographic Information Systems (GIS). RESULTS: CLD patients completed surveys [267 subjects, 56.5% female, age 55.8 ± 12.0, type of CLD: 36.5% hepatitis C (HCV), 19.9% hepatitis B (HBV), 19.9% non-alcoholic fatty liver disease (NAFLD); primary food source (PFS): 80.8% grocery store, secondary: 26.2% bulk food store, tertiary: 20.5% restaurants; fresh food (FF): 83%, pre-packaged (PP) 8.7%, already prepared (AP) 8.3%]. FF consumers had significantly fewer UEH servings/month (p = 0.030) and lived further away from convenience stores (1.69 vs. 0.95 km, p = 0.0001). Stepwise regression reveals the lowest FF consumers were NAFLD patients, subjects with UEH or restaurants and ethnic food stores as their PFS (R = 0.557, p = 0.0001). Eating already-packaged foods and utilizing restaurants or ethnic food stores as the PFS positively correlated with NAFLD (R = 0.546, p = 0.0001). CONCLUSIONS: Environmental food source measures, including type and density, should be included when examining areas hyper-saturated with a variety of food options. In hyper-saturated food environments, NAFLD patients consume more prepared food and less FF. CLD patients with UEH also eat significantly more prepared food and frequent restaurants and ethnic food stores as their PFS.

Role of exercise in optimizing the functional status of patients with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is frequently concomitant with obesity. This article discusses factors that influence health and functional outcomes of people who develop NAFLD, including increased burden of illness, whole body function, performance, and perception of self-efficacy. Changes in macronutrients, amount of calories consumed, and decreased physical activity all negatively influence patient outcome. The benefits of exercise in this population are also discussed. To be effective, exercise must be performed, regularly and in conjunction with dietary and other behavioral change. Therefore, a lifelong commitment to exercise, activity, and diet are needed if NAFLD is to be successfully treated.

Geographic distribution and socio-economic determinants of women's nutritional status in Mali households.

OBJECTIVE: Mali is one of the poorest countries in Africa, with 72% of its population surviving on less than $US 1.00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women's anthropometric status and use of adequately iodized salt among households in Mali. DESIGN: Demographic and Health Survey data, multistage-stratified cluster sampling methodology. SETTING: Rural and urban areas of Mali. SUBJECTS: Non-pregnant women (n 6015) between the ages of 19 and 44 years. RESULTS: Nineteen per cent of the women were overweight or obese while 11% were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the north-east and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women's BMI or households' use of adequately iodized salt. CONCLUSIONS: The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.

Maternal-child overweight/obesity and undernutrition in Kenya: a geographic analysis.

OBJECTIVE: The purpose of the study was to examine geographic relationships of nutritional status (BMI), including underweight, overweight and obesity, among Kenyan mothers and children. DESIGN: Spatial relationships were examined concerning BMI of the mothers and BMI-for-age percentiles of their children. These included spatial statistical measures of the clustering of segments of the population, in addition to inspection of co-location of significant clusters. SETTING: Rural and urban areas of Kenya, including the cities of Nairobi and Mombasa, and the Kisumu region. SUBJECTS: Mother-child pairs from Demographic and Health Survey data including 1541 observations in 2003 and 1592 observations in 2009. These mother-child pairs were organized into 399 locational clusters. RESULTS: There is extremely strong evidence that high BMI values exhibit strong spatial clustering. There were co-locations of overweight mothers and overweight children only in the Nairobi region, while both underweight mothers and children tended to cluster in rural areas. In Mombasa clusters of overweight mothers were associated with normal-weight children, while in the Kisumu region clusters of overweight children were associated with normal-weight mothers. CONCLUSIONS: These findings show there is geographic variability as well as some defined patterns concerning the distribution of malnutrition among mothers and children in Kenya, and suggest the need for further geographic analyses concerning the potential factors which influence nutritional status in this population. In addition, the methods used in this research may be easily applied to other Demographic and Health Survey data in order to begin to understand the geographic determinants of health in low-income countries.

Maternal-child nutrition practices and pediatric overweight/obesity in the United States and Chile: a comparative study.

Childhood overweight/obesity is now epidemic in both developed countries and those undergoing economic transition. This study compared maternal and school-age child nutrition practices and body mass index in the United States and in Chile. Children (125 in the United States, 121 in Chile) and their mothers (116 in the United States, 101 in Chile) participated. Findings indicated that child nutrition practices were comparable, but mothers in the U.S. group demonstrated fewer healthy nutrition practices on behalf of their children. Significant associations were found between maternal and child nutrition practices. Substantially more children in the U.S. sample were overweight/obese. Implications for practice are presented.

The growing burden of obesity in Thailand: a review of current trends and policies.

In recent years, there has been a rise in obesity-related diseases in transitional countries. These countries, once plagued with problems related to infectious disease and poverty, now face a dual burden of both chronic and infectious diseases. Thailand has recently experienced significant economic growth, and as a result, the numbers related to obesity and obesity-related diseases have risen significantly. Thailand is an important region to examine the timely issue of obesity-related policy because Thailand has been a model for successful public health interventions and policies throughout Asia. Further, such policies have significant implications for other regions of the world experiencing similar health transitions.

Relación entre prácticas alimentarias reportadas por niños chilenos y preferencias de los padres para su consumo / Relationship between reported dietary practices of Chilean children and their parents preferences for their consumption

The objective of this study was to examine agreement between parental preferences and self-reported food intake in Chilean children. In 2008,152 pairs, of 8 to 13 year old schoolchildren and their parents in Santiago were surveyed. Children self-reported their frequency of consumption of foods from various food groups. Parents reported how often they preferred their children to consume foods from these same food groups. Children reported consuming more sweets, high-calorie snacks, and fruit, and fewer grains than their parents reported preferring them to consume. Girls, 10 and 11 year olds, and children who watched television and used the computer for less than 2 hours per day had dietary patterns most closely aligned with their parents' reported preferences. Children 's dietary reports generally follow parental preferences. Intervention programs should include programs that facilitate parental guidance and encourage children to make healthy food choices at home and in school.

Se estudia concordancia entre preferencias de padres y auto-reporte de niños chilenos en consumo de alimentos. En 2008, se encuestaron 152 escolares ente 8 y 13 años de edad y sus padres, en Santiago, Chile. Los niños reportaron frecuencia de consumo de diferentes grupos de alimentos y los padres, frecuencia con que prefieren que sus hijos los consuman. Los niños informaron mayor consumo de dulces, colaciones altas en calorías y frutas y menor consumo de cereales, que lo declarado por sus padres. Los patrones alimentarios más estrechamente alineados con lo reportado por los padres se observan en: niñas; edades entre 10 y 11 años; ver televisión y utilizar computador menos de 2 horas diarias. En general, lo reportado por niños sigue los patrones de los padres. Programas de intervención debieran incluir guía a padres y estimulo a niños para elegir opciones alimentarias saludables en el hogar y en la escuela.

Maternal prepregnancy body mass index in relation to Hispanic preschooler overweight/obesity.

The aim of the current study was to examine the role of maternal prepregnancy body mass index (BMI) on overweight/obesity among US Hispanic children ages 2 and 4 years old. We used US nationally representative data from preschoolers enrolled in the Early Childhood Longitudinal Study-Birth Cohort study. The findings revealed that a significantly higher percent (41.6%) of Hispanic mothers were overweight/obese prior to pregnancy compared to white mothers (34.8%). At 2 years of age, 38.3% of the children born to Hispanic mothers were overweight/obese compared to 29.4% of children born to white mothers. By the age of 4, overweight/obesity increased significantly for both racial/ethnic groups with preschoolers whose mothers were Hispanic being more likely to be overweight/obese (44.6%) compared to children whose mothers were white (34.2%). Further, preschoolers born to overweight/obese Hispanic mothers were more than twice as likely [odds ratio = 2.74 (95% confidence interval (CI) 1.60, 4.69)] to be overweight/obese than those born to Hispanic mothers of normal prepregnancy BMI. Preschoolers born to overweight/obese white mothers were approximately 1.4 (95% CI 1.05, 1.93) times more likely to be overweight/obese in comparison to those born to mothers with a normal prepregnancy BMI. Maternal prepregnancy weight is potentially a modifiable risk factor for preschooler overweight/obesity. Study findings support the design of early and targeted interventions to reduce this risk to the long-term health of Hispanic maternal and child dyads.

Nutritional assessments of patients with non-alcoholic fatty liver disease.

BACKGROUND: Obesity is not only associated with nonalcoholic fatty liver disease (NAFLD) but it also adversely affects the progression of other liver diseases. There are limited data regarding the dietary habits of patients with chronic liver disease. METHODS: Nutrition surveys containing 13 different food groups were mailed. Nutrition scores were calculated based on weekly servings. Foods were also divided into USDA food pyramid categories with conversion of each group into calories expended. Clinico-demographic data were available. NAFLD patients were compared to patients with chronic viral hepatitis. RESULTS: A total of 233 subjects were included: age 52.5 +/- 10.0 years, Body mass index (BMI) 28.1 +/- 6.5, MS 24.2%, 31.8% NAFLD, 48.1% hepatitis C virus (HCV), and 20.2% hepatitis B virus (HBV). Six nutrition indices were different among the groups. NAFLD and HCV consumed more low-nutrient food (p = 0.0037 and 0.0011) and more high-sodium food than HBV (p = 0.0052 and 0.0161). Multivariate analysis showed that NAFLD and HCV consumed more high-fat sources of meat/protein than HBV (p = 0.0887 and 0.0626). NAFLD patients consumed less calories from fruits compared to HCV and HBV patients (p = 0.0273 and 0.0023). Nine nutrition indices differed according to BMI. Univariate analysis showed that obese/overweight patients consumed more high-fat sources of meat/protein (p = 0.0078 and 0.0149) and more high-sodium foods (p = 0.0089 and 0.0062) compared to the normal-weight patients. In multivariate analysis, normal-weight patients consumed more fruits than obese (p = 0.0307). Overweight patients also consumed more calories of meat and oil than normal-weight patients (p = 0.0185 and 0.0287). CONCLUSION: NAFLD and HCV patients have similar dietary habits. Patients with HBV have the healthiest dietary habits. Specific dietary interventions should focus on decreasing intake of low-nutrient and high-sodium food, as well as high-fat sources of meat/protein.

Maternal obesity, health status during pregnancy, and breastfeeding initiation and duration.

OBJECTIVE: The purpose of this study was to determine whether maternal prepregnancy overweight/obesity has independent effects on breastfeeding initiation and duration and whether these effects are different for women who experience medical problems during pregnancy or labor/delivery complications in comparison with those who have no medical or labor/delivery complications. METHODS: We used the early childhood longitudinal study-birth cohort data. Kaplan-Meier survival functions, logistic, and Cox regression modeling were used in the analyses. RESULTS: Findings indicate that overweight/obese women with medical or labor/delivery complications were less likely to initiate breastfeeding in comparison with their counterparts of normal weight. We did not find an independent effect of prepregnancy overweight/obesity on breastfeeding initiation among women with no medical problems. This group of women, however, had an 11% increased risk of stopping breastfeeding with each additional month of breastfeeding duration in comparison to those of normal weight. CONCLUSIONS: It is important to evaluate the health history and pregnancy complications among overweight/obese mothers in developing interventions for successful initiation and duration of breastfeeding.

Sociodemographic determinants of growth among Malian adolescent females.

In Africa, research concerning the social determinants of poor nutritional status has typically focused on children under 5 years of age and has used defined categorical boundaries based on international reference standards. In this article, stunting and wasting of 1,157 Malian adolescent girls is measured through both categorical and continuous data. The focus on adolescent girls is significant because there is relatively little literature examining this group, and because adolescence marks the time when girls gain greater workload responsibilities, autonomy of food choices, and, as a result of the adolescent growth spurt, require the greatest amount of caloric intake respective to their weight since infancy. To differentiate stunting and wasting causes, a number of socioeconomic, geographic, and demographic factors are explored. The findings suggest that continuous data provides a basis for modeling stunting and wasting superior to utilizing international reference categories. Estimations show that decreasing age, the presence of servants, a greater number of wives in a compound, and residence in a large urban area correlate with improved nutritional status while wealthier families appear to correlate with greater stunting and wasting, and no correlation exists with estimated energy expenditure. Future studies should incorporate continuous data, and the need exists for greater analysis of social determinants of growth indicators among adolescent females. Further, these findings have significant implications in the development of nutrition intervention programs aimed at the vulnerable population in Mali, leading us to conclude that factors beyond socioeconomic indicators such as household structure and location should be more fully examined.

Concepts of anemia among low income Nicaraguan women.

Anemia is a common health problem among women throughout the world, however, there has been minimal research on women's concepts of anemia. The purpose of this study was to examine concepts of anemia in low income Nicaraguan women. A qualitative design was used. Audio-taped open-ended interviews in Spanish with 14 women were used to obtain data. Tapes were transcribed and content analyzed. The findings indicate that few of the women had biomedically accurate concepts of anemia, such as that it was due to lack of iron from poor eating. Others held folk medical beliefs including home remedies, for example drinking the milk of a mare or beet juice and eating certain foods such as bean soup. Most of the women did not know any symptoms of anemia and a few reported that it can develop into leukemia. These concepts of anemia are instructive for nurses working with patients from Nicaragua and will be useful in developing nursing interventions to alleviate this public health problem.

Childhood obesity study: a pilot study of the effect of the nutrition education program Color My Pyramid.

The need for successful nutrition interventions is critical as the prevalence of childhood obesity increases. Thus, this pilot project examines the effect of a nutrition education program, Color My Pyramid, on children's nutrition knowledge, self-care practices, activity levels, and nutrition status. Using a pretest-posttest, quasiexperimental design, 126 fourth- and fifth-grade students from experimental and control schools are compared. The intervention program incorporates an online component www.MyPyramid.gov, Orem's Self-Care Deficit Nursing Theory, and consists of six classes taught over a 3-month period. Results indicated that the program increased nutrition knowledge in the control group. Furthermore, it increased activity time from pretest to posttest and decreased systolic blood pressure for children in both groups; however, there were no significant differences in BMI percentiles. The findings indicate that Color My Pyramid can be successfully employed in school settings and thus support school nursing practice.

Concepts of anemia among low income Nicaraguan women / Conceptos de anemia entre mujeres nicaragüenses de baja renta / Conceitos de anemia entre mulheres nicaragüenses de baixa renda

Anemia is a common health problem among women throughout the world, however, there has been minimal research on women's concepts of anemia. The purpose of this study was to examine concepts of anemia in low income Nicaraguan women. A qualitative design was used. Audio-taped open-ended interviews in Spanish with 14 women were used to obtain data. Tapes were transcribed and content analyzed. The findings indicate that few of the women had biomedically accurate concepts of anemia, such as that it was due to lack of iron from poor eating. Others held folk medical beliefs including home remedies, for example drinking the milk of a mare or beet juice and eating certain foods such as bean soup. Most of the women did not know any symptoms of anemia and a few reported that it can develop into leukemia. These concepts of anemia are instructive for nurses working with patients from Nicaragua and will be useful in developing nursing interventions to alleviate this public health problem.

La anemia es un problema de salud común entre las mujeres alrededor del mundo, sin embargo, se han realizado pocas investigaciones sobre los conceptos de anemia entre las mujeres. El propósito de este estudio fue examinar los conceptos de anemia en mujeres Nicaragüenses de bajos ingresos económicos. La investigación fue de orden cualitativa. Para la recolección de datos, se realizaron entrevistas semiestructuradas, grabadas en castellano, con 14 mujeres. Las cintas grabadas fueron transcritas y se realizó un análisis de contenido. Los resultados indican que pocas mujeres poseen conocimientos biomédicos sobre anemia, por ejemplo, la ingestión de alimentos pobres en hierro. Otras expresaron creencias populares, como remedios caseros, ingestión de leche de yegua o jugo de remolacha y ciertos alimentos como sopa de judías. La mayoría de las mujeres no conocía ningún síntoma de anemia y pocas relataron que creían que esta enfermedad podría transformarse en leucemia. Estos conceptos de anemia son instructivos para las enfermeras que trabajan con pacientes en Nicaragua y será de mucha utilidad para desarrollar intervenciones de enfermería para aliviar este problema de salud pública.

A anemia e um problema de saúde comum entre as mulheres de todo a mundo inteiro, mas tem havido um mínimo de investigação sobre os conceitos de anemia entre as mulheres. O objetivo deste estudo foi o de analisar os conceitos de anemia em mulheres nicaragüenses com baixos rendimentos. Foi utilizado um desenho qualitativo. Para a coleta de dados, entrevistas semi-estruturadas foram conduzidas, áudio gravadas em espanhol para 14 mulheres. As fitas foram transcritas e tornou-se uma análise conteúdo. Os resultados indicam que poucas mulheres possuem conhecimento biomédico preciso sobre anemia, tal como ingestão de alimentos pobre em ferro. Outras mantiveram outras crenças populares incluindo remédios caseiros, ingestão de leite de égua ou suco de beterraba e certos alimentos como sopa de feijão. A maioria das mulheres não conhecia nenhum sintoma de anemia e poucas relataram que pode progredir para leucemia. Estes conceitos de anemia são esclarecedores para os enfermeiros que trabalham com doentes na Nicarágua e que será muito útil para desenvolver intervenções de enfermagem para minorar o problema de saúde pública.

The effect of a nutrition education program on the nutritional knowledge, hemoglobin levels, and nutritional status of Nicaraguan adolescent girls.

OBJECTIVES: The purpose of this study was to examine the effect of a community-based nutrition education program on the nutritional knowledge, hemoglobin levels, and nutritional status of Nicaraguan adolescent girls and the nutritional knowledge of their mothers. THEORY: Self-care deficit nursing theory was used in this study. DESIGN: This longitudinal study used a mixed quantitative/qualitative design to study the effect of the nutrition education program. SAMPLE: The nonprobability sample consisted of 182 adolescent girls and 67 of their mothers. The setting for the study was a community (barrio) in Managua, Nicaragua. INTERVENTION/MEASUREMENT: A team of nurse and nutrition researchers created the nutrition education program designed to improve girls' and mother's nutrition-related self-care operations. Data collection was carried out for 4 years for girls and 2 years for mothers in Managua, Nicaragua, using questionnaires, a HemoCue, and anthropometric measures. RESULTS AND CONCLUSION: The findings of this study were that girls' and mothers' nutritional knowledge scores significantly improved in most cases after participation in the nutrition intervention program. Girls' hemoglobin levels did not significantly improve and their nutritional status findings were mixed. Girls and mothers described what dietary changes girls made and why.

A cross-sectional examination of growth indicators from Thai adolescent girls: evidence of obesity among Thai youth?

BACKGROUND: Few studies have examined growth data from adolescent girls in Southeast Asia and almost none have been carried out in Thailand. Thus this study examines growth data from Thai adolescent girls. AIM: Cross-sectional growth data from a sample of Thai girls were compared to reference data from healthy well-nourished girls. It is hypothesized that the reference girls will be taller and heavier than the Thai girls; however, the growth indicators will also indicate that obesity is present among Thai girls. SUBJECTS AND METHODS: Anthropometric and age at menarche data were collected from a sample of 319 adolescent girls ages 11-17 years living in suburban Thailand. RESULTS: Thai girls are heavier than the reference girls at ages 11-13 years yet are shorter and lighter than the reference girls at ages 14-17 years. The data also reveal that 18.4% of the girls are overweight or obese as classified by the CDC BMI-for-age percentile growth curves. CONCLUSION: The findings suggest the presence of overweight and obesity among this adolescent Thai population. These data may reflect the impact of the improved economic situation of Thailand as well as the impact of body image concerns among these young girls.

Classification tree analysis of stunting in Malian adolescent girls.

This study examines relationships between growth data and energy expenditure, economic status, and family structure among Malian adolescent girls, aged 10-17 years living in the Segou Region of Mali. Classification and regression trees (CART) were used as the primary methodology to identify high-risk subgroups for stunting (measured as height-for-age) in a sample of 1,103 Malian adolescents. Because CART has been used rarely to examine growth and development, this study provides a new way to better understand how economic status, family structure, and energy expenditure related factors influence stunting in Mali. The findings indicate that the greater the number of sisters and women in a household, the poorer the nutritional status of adolescent girls. The data also show that the presence of servants within the household may predict better nutritional success of young girls. Energy expenditure was an important predictor in the context of family structure regarding the number of sisters and the presence of servants. Wealth indicators did not appear in the final tree, suggesting that wealth may not play as great a role in predicting poor growth and nutritional status as family size and structure. In conclusion, classification trees may assist in understanding the interactive nature of predictive factors of stunting in this population, and further provide evidence for intervention programs aimed at improving the health and nutritional status of Malian adolescent girls.

Impact of a nutrition intervention program on the growth and nutritional status of Nicaraguan adolescent girls.

This research examines the impact of a nutrition education intervention program on the nutritional status and knowledge of Nicaraguan adolescent girls. Anthropometric measurements, hemoglobin values, and data concerning nutritional knowledge were collected from adolescent girls living in Managua, Nicaragua. Using a pre-test/post-test design, data are compared prior to and after the nutrition intervention program. When using Mexican American reference data, statistically significant differences in height-for-age z-scores and weight-for-age z-scores were found when comparing the entire sample of baseline data with data collected after three years of the nutrition intervention program (p < 0.05). Significant improvement was also found concerning the indicators of nutritional knowledge (p < 0.05). However, hemoglobin data revealed a significant decrease which may be due to specific environmental factors and pubertal changes. This research has implications concerning the development of successful adolescent focused nutrition intervention programs in Nicaragua, and examines the possibility that catch-up growth occurs during adolescence.