Jeannine C. Lawrence

What proportion of preschool-aged children consume sweetened beverages?

BACKGROUND Obesity affects nearly 17% of US children and youth 2-19 years old and 10% of infants and toddlers under the age of 2 years. One strategy for addressing obesity is to discourage sugar-sweetened beverage (SSB) consumption. Compared with their older school-aged counterparts, children ≤ 5 years depend largely on parents for the purchase and serving of SSBs. Therefore, recognizing parental factors associated with childrens intake of SSBs is important. METHODS This study used cross-sectional data from parents of children ≤ 5 years old to examine SSB consumption and associated factors. Elements of the Health Belief Model and Theory of Reasoned Action facilitated data analysis and interpretation. RESULTS The most consistent predictor of SSB intake was child age. Nearly 94% of children aged 3-5 years consumed sweetened milk products, 88% consumed fruity drinks, 63% consumed sodas, and 56% consumed sports drinks and sweet tea. Adjusting for all other factors, the only parental psychosocial factor associated with SSB intake was self-efficacy (predicting fruity drinks consumption). CONCLUSIONS More children drink SSBs as they get older. Interventions designed to prevent SSB consumption should occur early, before children reach preschool age. Additional study of parental factors influencing SSB intake in early childhood is recommended.

A theoretically based Behavioral Nutrition Intervention for Community Elders at high risk: the B-NICE randomized controlled clinical trial.

We conducted a study designed to evaluate the efficacy and feasibility of a multilevel self-management intervention to improve nutritional intake in a group of older adults receiving Medicare home health services who were at especially high risk for experiencing undernutrition. The Behavioral Nutrition Intervention for Community Elders (B-NICE) trial used a prospective randomized controlled design to determine whether individually tailored counseling focused on social and behavioral aspects of eating resulted in increased caloric intake and improved nutrition-related health outcomes in a high-risk population of older adults. The study was guided by the theoretical approaches of the Ecological Model and Social Cognitive Theory. The development and implementation of the B-NICE protocol, including the theoretical framework, methodology, specific elements of the behavioral intervention, and assurances of the treatment fidelity, as well as the health policy implications of the trial results, are presented in this article.

Obesity-Related Inflammation: Implications for Older Adults

The combination of age-related increases in obesity and inflammation can lead to chronic disease, decreased strength, and physical disability. Lifestyle interventions that include moderate caloric restriction along with aerobic and resistance exercise have shown improvements in metabolic outcomes, strength, and physical function in obese older adults. Although few weight loss studies have addressed diet quality, evidence summarized in this review suggests that encouraging intake of antioxidant-rich fruits and vegetables, high-quality protein, low-glycemic index carbohydrates, and omega-3 fatty acids may further ameliorate obesity-related inflammation. Future controlled trials are indicated to examine the effects of incorporating these foods into multimodal weight loss interventions.

College Students Must Overcome Barriers to Use Calorie Labels in Fast-Food Restaurants

OBJECTIVE To explore predictors of intention of college students to use calorie labels on fast-food menus and differences in calories ordered after viewing calorie information. DESIGN Quasi-experimental design. Participants selected a meal from a menu without calorie labels, selected a meal from the same menu with calorie labels, and completed a survey that assessed demographics, dietary habits, Theory of Planned Behavior constructs, and potential barriers to use of calorie labeling. SETTING A southern university. PARTICIPANTS Undergraduate university students (n = 97). MAIN OUTCOME MEASURES Predictors of intention to use calorie labels and whether calories selected from the nonlabeled menu differed from the labeled menu. ANALYSIS Confirmatory factor analysis, exploratory factor analysis, multiple regression, and paired t tests. RESULTS Participants ordered significantly fewer calories (P = .02) when selecting from the labeled menu vs the menu without labels. Attitudes (P = .006), subjective norms (P < .001), and perceived behavioral control (P = .01) predicted intention to use calorie information but did not predict a difference in the calories ordered. Hunger (P = .03) and cost (P = .04) were barriers to using the calorie information. CONCLUSIONS AND IMPLICATIONS If students can overcome barriers, calorie labeling could provide information that college students need to select lower-calorie items at fast-food restaurants.

Environmental Considerations for Improving Nutritional Status in Older Adults with Dementia: A Narrative Review

As the number of older adults in the United States continues to grow, the American health care system will face the unique challenge of providing care for these individuals, including many who will be diagnosed with some form of dementia. As dementia progresses, patients require increasing amounts of care and nutrient intake usually declines. This tends to result in weight loss, malnutrition, and increased morbidity and mortality. Various interventions have been developed with the goal of improving meal intake and reducing unintentional weight loss in patients with dementia. Several studies have shown that meal intake improves with the provision of adequate assistance, either from staff members or from volunteer feeding assistants. Some studies have focused on the method of meal service and its influence on meal intake and nutrition status. Both buffet-style and family-style dining have shown promising results in terms of improving meal intake and quality of life among older adults in long-term-care settings. Other environment-related interventions include improving lighting and visual contrast, altering the dining room to more closely resemble a home-style setting, using the aroma of food to stimulate appetite, using routine seating arrangements, and using relaxing or familiar music in the dining room to provide a calmer environment. The purpose of this review is to evaluate the research on environment-based interventions to improve nutritional status among older adults with dementia, to describe potential for practical applications, and to identify gaps in the existing literature whereon further research is warranted.

Variability in results from predicted resting energy needs as compared to measured resting energy expenditure in Korean children

Energy needs are influenced by many factors, including ethnicity. Multiple studies have shown that the accuracy of an energy prediction equation varies with the ethnic background of the study population. Therefore, it is crucial to identify the most accurate energy prediction equation to use for a given population. This study compared measured resting energy expenditure to results from commonly-used energy prediction equations to identify the most accurate equation to use for Korean children. Based on previous literature showing wide variation in accuracy of energy prediction equations in different ethnic groups, we hypothesized that results from measured- vs. predicted energy needs would be significantly different in this population. Subjects were 92 South Korean children (38 boys, 54 girls) age 7.7 +/- 2.7 years (mean +/- SD). Measurements included: resting metabolic rate (TrueOne 2400 metabolic cart), weight/height (digital scale/stadiometer); body fat (BIA, Inbody720), blood pressure (sphingomanometer), triceps skinfold thickness (MD-500 skinfold calipers), muscle mass (Heymsfields formula) and body surface area (Dubois formula) calculations. Resting energy needs were predicted using the Harris-Benedict, WHO/NAO/FAO, Altman and Dittmer, Maffeis, and Schofield-HW equations, and the Dietary Reference Intake recommendations. Measured and predicted energy needs were significantly correlated (P < .001 for all; range R(2) = 0.54-0.56), yet significantly different for all equations studied (P < .05) except the Maffeis and Schofield-HW equations. Differences (means +/- SD) between measured vs. predicted energy needs ranged from 9.5 +/- 123.2 (Schofield-HW) to 199.6 +/- 132.7 (WHO/NAO/FAO) kcal/day, where a value closer to zero indicates increased accuracy of the prediction equation to correspond to measured energy needs. Although results from equations studied were significantly correlated with measured resting energy needs, notable discrepancies existed which, over time, could produce undesirable weight changes in Korean children.

Social Ecological Perspectives of Tube-Feeding Older Adults with Advanced Dementia: A Systematic Literature Review

ABSTRACT Dementia is a progressive, debilitating disease that often results in weight loss, malnutrition, and dehydration. Feeding tubes are often prescribed; however, this practice can lead to complications. The purpose of this systematic review was to examine the use of feeding tubes in elderly demented patients from a social ecological perspective. Results indicated that family members often receive inadequate decision-making education. Many health care professionals lack knowledge of evidence-based guidelines pertaining to feeding tube use. Organizational and financial reimbursement structures influence feeding tube use. Feeding practices for patients with advanced dementia is a complex issue, warranting approaches that target each level of the Social Ecological Model.

College Students' Intentions to Use Calorie Information on a Restaurant Menu: Application of the Theory of Planned Behavior

Background: Obesity continues to be an epidemic in the United States and is associated with multiple chronic diseases. Greater numbers of people eat in restaurants and select high calorie foods. Labeling laws require calorie information on menus in some restaurants. Purpose: The purpose of this study was to determine the predictors of intention to use calorie labels among college students using constructs of the Theory of Planned Behavior (TPB). Methods: College students selected a meal from a menu without calories and from the same menu with calorie information, and completed a survey that addressed TPB constructs. Regression analysis was used to determine predictors of intention to use labels and calorie changes of meals ordered. Results: Students (n = 100) ordered significantly fewer calories with posted calorie information. Intention was significantly correlated with attitudes, subjective norms, and perceived behavioral control. Discussion: The TPB may help explain factors involved in the intention to use posted calorie information on a restaurant menu. Results support the inclusion of the calorie statements on these menus. Translation to Health Education Practice: Education efforts should include constructs of the TPB. When planning, implementing and evaluating programs, utilizing strategies to influence attitudes, subjective norms and perceived behavioral control is suggested.

Protein-enhanced soups: a consumer-accepted food for increasing dietary protein provision among older adults

Abstract Protein-enhanced soups (PES) may improve protein intake among older adults. This study examined sensory attributes (aroma, texture, taste, and overall acceptability) and preferences of PES (chicken noodle and cheddar broccoli) compared with flavor-matched control soups (FCS) among older adults (≥65 years) and evaluated dietary profile changes of a standard menu based on the substitution of one PES serving/d for a standard soup. Modified paired preference tests and 5-point facial hedonic scales were administered to participants (n = 44). No significant differences in sensory attributes between either PES compared with FCS were identified, but significant gender- and age-related differences (p < 0.05) were observed. About Sixty-one percent of participants preferred protein-enhanced chicken noodle soup while only 38% preferred protein-enhanced cheddar broccoli soup to their respective FCS. Substituting one PES serving for one non-fortified soup serving per day resulted in significantly higher (p < 0.001) protein profile. Results suggest that all attributes of PES were consistent with sensory expectations and PES substitution could improve protein provision.

Understanding college students’ intention to consume fruits and vegetables: an application of the Model of Goal Directed Behavior

ABSTRACT The Model of Goal-directed Behavior (MGB) was used to examine factors influencing college students’ intentions to consume fruit and vegetable (F&V). College students, ages 19 years or older pursuing any undergraduate major at The University of Alabama participated in this cross-sectional study. Participants completed validated survey instruments measuring attitude, subjective norm, perceived behavioral control, intention, positive anticipated emotion, negative anticipated emotion, past behavior and desire. Structural equation modeling (SEM) was used to examine psychosocial determinants of intention to consume F&V among college students. Desire had a significant positive relationship with intention. Although desire was not significantly influenced by attitude, subjective norm, or perceived behavioral control, positive anticipated emotion had a significant positive relationship with desire. Past behavior had a significant relationship with both desire and intention. In addition, college students’ intention to consume F&V was significantly influenced by perceived behavioral control. Findings from this study suggest that desire is critical in prompting behavior change. Further, factors influencing desire and/or intention in this population include positive anticipated emotions, past behavior and perceived behavioral control. Abbreviations: Model of goal directed behavior – MGB, fruits and vegetable –F&V