Brandy-Joe Milliron

A Point-of-Purchase Intervention Featuring In-Person Supermarket Education Affects Healthful Food Purchases

OBJECTIVE This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases. DESIGN The design was a randomized trial comparing the intervention with usual care (no treatment). SETTING AND PARTICIPANTS A supermarket in a socioeconomically diverse region of Phoenix, AZ. One hundred fifty-three adult shoppers were recruited onsite. INTERVENTION The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket point-of-purchase healthful shopping program that included posted shelf signs identifying healthful foods, sample shopping lists, tips, and signage. MAIN OUTCOME MEASURES Outcomes included purchases of total, saturated, and trans fat (grams/1,000 kcal), and fruits, vegetables, and dark-green/yellow vegetables (servings/1,000 kcal) derived through nutritional analysis of participant shopping baskets. ANALYSIS Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income. RESULTS The intervention resulted in greater purchasing of fruit and dark-green/yellow vegetables. No other group differences were observed. CONCLUSIONS AND IMPLICATIONS Long-term evaluations of supermarket interventions should be conducted to improve the evidence base and to determine the potential for influence on food choices associated with decreased chronic disease incidence.

Usual Dietary Intake among Female Breast Cancer Survivors Is Not Significantly Different from Women with No Cancer History: Results of the National Health and Nutrition Examination Survey, 2003-2006

Dietary intake is a modifiable behavior that may reduce the risk of recurrence and death among breast cancer survivors. Cancer survivors are encouraged to consume a diet rich in fruit, vegetables, and whole grains and limit red meat, processed meat, and alcohol intake. Using data from the National Health and Nutrition Examination Survey (2003-2006), this study examined whether breast cancer survivors and women with no history of cancer differed in the distribution of usual intake of foods included in the dietary recommendations for preventing cancer and recurrences. Participants completed one or two 24-hour dietary recalls. The food groups included in this analysis were whole fruit; total vegetables; dark green and orange vegetables; whole grains; red meat; processed meat; alcohol; and calories from solid fat, alcohol, and added sugar. The National Cancer Institute Method was used to estimate the distribution of usual intake and to compare breast cancer survivors (n=102) to noncancer respondents (n=2,684). Using age and cancer survivor as covariates, subgroup estimates of usual intake were constructed. No significant group differences were found, except that survivors reported a greater intake of whole grains. More than 90% of both groups did not meet recommendations for fruits, vegetables, and whole grains; 75.4% and 70.2%, respectively, consumed less than the red meat recommendation; and <10% of either group met the recommendation for percent energy from solid fat, alcohol, and added sugar. The diet of breast cancer survivors was not significantly different from women with no history of cancer.

Lower Healthy Eating Index-2005 dietary quality scores in older women with rheumatoid arthritis v. healthy controls

OBJECTIVE To assess the dietary quality of older women with and without rheumatoid arthritis (RA) using the Healthy Eating Index-2005 (HEI-2005) to identify potential strategies to improve the nutritional status. DESIGN Cross-sectional. Diet was assessed using 7 d food records and analysed for nutrient composition (Food Processor v. 7.11). Diet quality was determined using the HEI-2005, a measure of compliance with 2005 US Dietary Guidelines. Individuals with RA completed a self-reported evaluation of arthritis (pain scale and disability index). Independent two-tailed t tests or Mann-Whitney tests compared the differences between groups and correlations were computed between HEI-2005 and measures of disease reactivity. SETTING Arizona, USA. SUBJECTS Older (> or = 55 years) women (n 108) with RA (n 52) and healthy controls (HC; n 56). RESULTS There were no differences between groups in age, weight, or BMI (kg/m2). HC participants had higher mean HEI-2005 scores for whole fruit (cups; P = 0.02), total fruit (cups; P = 0.05), whole grains (oz; P = 0.004), oil (g; P = 0.05) and total HEI score (P = 0.04) than the RA group. In the RA group, these same HEI components were inversely correlated with disability index (r = -0.20, P = 0.04). Participants with RA reported lower mean intakes of carbohydrate (g; P = 0.02), fibre (g; P = 0.01) and vitamin C (mg; P = 0.04). CONCLUSIONS This is the first study examining the dietary quality in older women with and without RA using the HEI-2005. Living with RA was associated with significantly lower dietary quality. Since even small changes in dietary quality can translate into better nutritional status, future interventions should focus on increasing dietary quality in this high-risk group.

Surge in US outpatient vitamin D deficiency diagnoses: National Ambulatory Medical Care Survey analysis.

Objectives In light of the growing medical interest in the potential consequences of vitamin D deficiency, it is important that clinicians are informed about the varying factors that may complicate the assessment of vitamin D status and the diagnosis of deficiency. To better understand the frequency of vitamin D deficiency diagnoses in the ambulatory setting over time, the objective of this investigation was to examine unspecific, general, and bone-related vitamin D deficiency diagnoses between 2007 and 2010 and to determine whether the rate of diagnoses differed by patient age and sex. Methods We used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to assess the rate of vitamin D deficiency diagnoses provided between 2007 and 2010 during outpatient visits with nonfederally employed physicians in offices and hospitals. Two hundred ninety-two unweighted patient visit records were included. Trends in vitamin D deficiency diagnosis over time, diagnosis of bone disease associated with a vitamin D deficiency diagnosis, and patient age and sex were reported. Results The number of diagnoses for vitamin D deficiency rapidly increased from 2007 to 2010. More than 97% of diagnoses were for unspecific vitamin D deficiency; 9.6% of vitamin D deficiency visits also resulted in a diagnosis of osteoporosis or bone fracture. Conclusions Although the rate of diagnoses for vitamin D deficiency increased between 2007 and 2010, many diagnoses rendered were for nonspecific disease; therefore, vitamin D deficiency screening may have been ordered for preventive care purposes rather than as a diagnostic aid.

Process Evaluation of a Community Garden at an Urban Outpatient Clinic

In addition to expediting patient recovery, community gardens that are associated with medical facilities can provide fresh produce to patients and their families, serve as a platform for clinic-based nutrition education, and help patients develop new skills and insights that can lead to positive health behavior change. While community gardening is undergoing resurgence, there is a strong need for evaluation studies that employ valid and reliable measures. The objective of this study was to conduct a process evaluation of a community garden program at an urban medical clinic to estimate the prevalence of patient awareness and participation, food security, barriers to participation, and personal characteristics; garden volunteer satisfaction; and clinic staff perspectives in using the garden for patient education/treatment. Clinic patients (n = 411) completed a community garden participation screener and a random sample completed a longer evaluation survey (n = 152); garden volunteers and medical staff completed additional surveys. Among patients, 39% had heard of and 18% had received vegetables from the garden; the greatest barrier for participation was lack of awareness. Volunteers reported learning about gardening, feeling more involved in the neighborhood, and environmental concern; and medical staff endorsed the garden for patient education/treatment. Comprehensive process evaluations can be utilized to quantify benefits of community gardens in medical centers as well as to point out areas for further development, such as increasing patient awareness. As garden programming at medical centers is formalized, future research should include systematic evaluations to determine whether this unique component of the healthcare environment helps improve patient outcomes.

Weight Loss Intervention in Survivors of ER/PR-negative Breast Cancer

Numerous studies have found that increased body size (weight or body mass index) is a risk factor for breast cancer development, recurrence, and death. The detrimental relationship between body size and breast cancer recurrence may be more pronounced among women with estrogen receptor (ER)/progesterone receptor (PR)-negative breast cancer. Considering the limited availability of treatments, and the association between body size and recurrence, alternative treatments are needed for ER/PR-negative breast cancer survivors, particularly overweight survivors. The objective of this pilot study was to examine the feasibility of a 12-week, multi-component meal-replacement weight loss intervention among overweight or obese ER/PR-negative breast cancer survivors; and to obtain preliminary data on changes in anthropometrics, biomarkers, and health-related quality of life (QOL). The 12-week intervention included a portion-controlled diet (including meal replacements) and a multi-component intervention (including behavioral techniques, diet modification, physical activity, and social support). The goal of the intervention was to help participants lose 5% or more of their initial weight by reducing their caloric intake and increasing their physical activity (to at least 15 minutes each day). Paired t-tests assessed changes in continuous measures. Body weight was measured weekly and mixed-model regression analysis assessed change in weight over time. Nineteen ER/PR-negative breast cancer survivors with a mean age of 59 years participated in the study. All but two of the participants completed the 12-week intervention. Women lost an average of 6.3 ± 4.9 kg (P < 0.001), equivalent to 7.5% of their baseline weight. There were significant reductions in waist circumference (P = 0.001), percent fat mass (P < 0.001), total cholesterol (P = 0.026), and triglycerides (P = 0.002); and improvements in health-related QOL (P = 0.017). Findings suggested that a meal-replacement weight loss approach among ER/PR-negative breast cancer survivors was feasible and was well received.

A disease of the present: scurvy in "well-nourished" patients.

To the Editor: Scurvy, vitamin C (ascorbic acid) deficiency, is linked historically to sailors and unbalanced diets. Despite current accessibility to foods containing ascorbic acid, we present two recent cases of scurvy in otherwise apparently “well fed” individuals. A 30-year-old man was admitted for anemia (hemoglobin 7.9 g/dL), leg hematoma, and rash. The patient had been healthy, but exclusively ate fast food with almost no intake of fresh fruits or vegetables. He had poor dentition without gingival bleeding and multiple perifollicular papules on the legs with corkscrew hairs (Fig 1). A biopsy of one of the petechial lesions on the leg revealed histologic findings consistent with scurvy (Fig 2). The patients serum vitamin C level was less than 0.12 mg/dL (normal 0.2-1.9 mg/dL). After the patient was prescribed 2000 mg of ascorbic acid daily, his eruption improved. Fig 1 Scurvy. Multiple perifollicular papules and petechiae with corkscrew hairs on the legs of Patient 1. Fig 2 Scurvy. Routinehematoxylin-eosin stain at 10× showing a superficial perivascular and perifollicular lymphohistiocytic infiltrate (black arrows) with numerous perifollicular extravasated red blood cells. Follicular hyperkeratosis (red arrowhead ... A 55-year-old woman with a history of hypothyroidism, hepatic hemangioma, and fatty liver presented with a new leg rash. She had small, nonpruritic, petechial perifollicular macules on bilateral lower extremities. Based on clinical findings and serum vitamin C level less than 0.12 mg/dL, scurvy was diagnosed. After several days of multivitamin supplementation, her eruption improved. Retrospectively, she reported eating only ½ cup or less of fruits and no vegetables daily and consuming 10 to 14 meals per week at common fast food restaurants. She drank several cans of diet soda 3 or more times per day, expressed a dislike for orange juice, and had been taking no multivitamins. Fast food intake has dramatically increased since the 1970s.1 Time constraints, convenience, and lifestyle have increased the contribution of fast food in the American diet,2 accounting for nearly 50% of an average familys food budget.3,4 Fast food intake is associated with a higher intake of fried potato, hamburger, pizza, and soft drinks, and lower intake of fruits, vegetables, and milk.1,2 While many fast food restaurants offer more healthful choices, patrons may not select these items. Despite availability of healthy fast food options in Australian restaurants, a small minority of Australians were purchasing them.5 A cultural change may be needed before Americans choose healthier substitutes over the traditional burger and fries. Even though scurvy had become rare in the developed world, a resurgence of scurvy may be another indication of the larger problem with the American diet, a diet with insufficient intake of fresh foods and with implications for obesity and diabetes.

Barriers and facilitators to healthy eating and disease self-management among older adults residing in subsidized housing:

Background: As adults transition into older ages, meeting age-specific dietary recommendations can become increasingly challenging, especially for low-income seniors who reside in publicly subsidized rental housing. Aim: The primary objectives of this study were to: 1) identify barriers and facilitators to healthy eating and self-management of nutrition-related chronic illnesses experienced by low-income seniors residing in a subsidized housing setting; and 2) assess the interest in community nutrition programming among low-income seniors residing in a subsidized housing setting. Method: A qualitative study design, using food focus groups and food pantry observations, was used. Participants included 24 male and female senior adults, between 65 and 75 years of age, residing in a subsidized housing community in Philadelphia, PA. This setting also included the unique features of a community garden and food pantry. Data were manually analyzed using a content analysis approach, which included familiarization, identification of themes, categorization and interpretation; and verified using NVivo 10. Results: Personal barriers, including food cost and accessibility, physical limitations, desire for convenience, and low self-efficacy to change dietary habits, inhibited motivation to change. External barriers in the food environment, including lack of transportation and distance of markets to access fresh produce, were commonly cited; as well as negative influences of the internal environment, such as the presence of vending machines, common cultural cooking and eating practices, and the lack of social cohesion. Facilitators focused on food preparation and recipe adaptation. Conclusions: Participants expressed an interest in learning more about food, nutrition, and health through community-based programming.

Use of a meal replacement weight loss intervention in survivors of ER/PR-negative breast cancer.

166 Background: The detrimental relationship between body mass index and recurrence has been more pronounced among women with estrogen receptor/progesterone receptor (ER/PR)-negative breast cancer. Although studies have reported that soy-based meal replacements can favorably impact weight and other metabolic risk factors, meal replacement strategies have not been tested in this population. The objectives of this pilot study were to determine the feasibility of a soy-based meal replacement intervention, to measure changes in anthropometrics and biomarkers, and to measure changes in health-related quality of life (QOL). METHODS The 3-month intervention included education sessions, meal replacement products, meal plans, and physical activity promotion. Anthropometrics, blood samples, and questionnaire data were collected. Paired t-tests assessed changes over time in continuous measures. Weights were measured weekly and a mixed model regression analysis assessed change in weight over time. RESULTS Nineteen women participated in the study (mean age 59 years). When comparing pre and post intervention weights, women lost ~7.5 ± 4.9 kg (p < 0.001) and had significant improvements in health-related QOL. Women lost 7.5% of their baseline weight which exceeded our study goal (5% reduction). There were significant reductions in waist circumference (-7.5 ± 4.9 cm, p = 0.001), % fat mass (-9.4 ± 8.3, p < 0.001), total cholesterol (p = 0.026), and triglycerides (p = 0.002). CONCLUSIONS The use of this weight loss approach was well-received by the study participants. We are currently evaluating whether this approach had a long-term impact on the weight status and quality of life among the study participants. [Table: see text].